Министерство здравоохранения России
ФГБОУ ВО Амурская Государственная Медицинская Академия
Студенческое научное общество
Ministry of Public Health of Russian Federation
Amur State Medical Academy
Students’ Scientific Society
СБОРНИК ТЕЗИСОВ ДОКЛАДОВ
26Я НАУЧНАЯ СТУДЕНЧЕСКАЯ
КОНФЕРЕНЦИЯ НА ИНОСТРАННЫХ ЯЗЫКАХ
ABSTRACTS
26th SCIENTIFIC STUDENTS
CONFERENCE IN FOREIGN
LANGUAGES
19 ДЕКАБРЯ 2016 г.
Благовещенск 2016 г.
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Министерство здравоохранения России
ФГБОУ ВО Амурская Государственная Медицинская Академия
Студенческое научное общество
Ministry of Public Health of Russian Federation
Amur State Medical Academy
Students’ Scientific Society
СБОРНИК ТЕЗИСОВ ДОКЛАДОВ
26Я НАУЧНАЯ СТУДЕНЧЕСКАЯ
КОНФЕРЕНЦИЯ НА
ИНОСТРАННЫХ ЯЗЫКАХ
ABSTRACTS
26th SCIENTIFIC STUDENTS
CONFERENCE IN FOREIGN
LANGUAGES
19 ДЕКАБРЯ 2016 г.
Благовещенск 2016 г.
3
Сборник тезисов докладов 26ой научной студенческой конференции на
иностранных языках содержит тезисы 600 докладов, заслушанных на трёх
секциях:
 Английского языка
 Немецкого языка
 Французского и латинского языков
Редакционная коллегия:
 проф., д.м.н. Т.В. Заболотских—ректор Амурской ГМА;
 проф., д.м.н. С.С. Целуйко—проректор по научной работе;
 проф., д.м.н. Е.А. Бородин—председатель Совета по
НИИРС Амурской ГМА (ответственный редактор)
 Н.А. Ткачева—зав.кафедрой иностранных языков
Амурской ГМА;
 П.Е. Бородин—член СНО Амурской ГМА (технический редактор)
Редакционная коллегия не ставит задачей рецензирование и редактирование
представленных в сборнике работ студентов, которые публикуются в
оригинальном виде. Ответственность за содержание работ лежит на авторах и
научных руководителях, как это общепринято при публикации материалов
конференций, симпозиумов, конгрессов и т.д.
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DRUG RESISTANCE OF MYCOBACTERIUM TUBERCULOSIS
Blagova Zh. – the 3rd year student
Scientific leaders - Dr. Med. Sc. Makarov I.Yu., Kostina V.V.
Tuberculosis is one of the 10 leading causes of death in the world. In 2015, there
were 10.4 million of TB sick people, and 1.8 million of people (including 0.4 million of
people with HIV) died from the disease. According to WHO estimation, the share of the
Russian Federation accounts for 1.7% of the total number of cases in the world. Indicators
of the effectiveness of treatment of TB patients in the Russian Federation are not high,
although on average, in the countries of the world in 2009, the treatment was effective in
87% of new cases. This is due to multidrug-resistant (MDR-TB). This form of tuberculosis
is caused by the bacterium Mycobacterium tuberculosis, not reacting at least isoniazid and
rifampicin, the two most powerful first-line anti-TB drugs. MDR-TB can be treated and
cured using second-line drugs. However, such treatment options are limited and require
extensive chemotherapy (treatment duration up to two years) by drugs that have a high cost
and toxicity. In some cases, it may develop more serious drug resistance. TB with
extensively drug resistant TB (XDR-TB) is a more severe form of MDR-TB caused by
bacteria does not respond to the most effective anti-TB second-line drugs, in which patients
often do not remain any further treatment options. In 2015, approximately 480,000 of
people in the world, there developed MDR-TB. The highest burden of MDR-TB problem
lies on the three countries - China, India and the Russian Federation - the part of which in
total account is nearly half of all cases worldwide. Currently, worldwide success of MDRTB treatment is achieved in 52% of patients, and XDR-TB in 28% of patients. Thus, the
problem of drug resistance in Mycobacterium tuberculosis is one of the leading in the field
of medical science and its relevance will persist for quite a long time, not only in our
country, but throughout the world.
TARGETING THE MICROENVIROMENT IN ADVANCED COLORECTAL
CANCER
Ustinov E. – the 1-st year student
Scientific leaders - T.L. Ogorognikova., E.A Volosenkova
Rectum is the final part of the digestive tract, named so because of its straight form.
The wall of the rectum is made up of the same shells as the wall of the colon: mucosa,
submucosa and muscle membrane. The mucous membrane consists of epithelium muscular
and own plates. Epithelium: In the upper part - a single-layer prismatic, columnar zone of
the lower division - multi-layered cube, in the intermediate - stratified squamous nonkeratinized in skin - stratified squamous keratinized. The plate it self is a layer of loose
connective tissue. Like any epithelial tissue, because of many factors, colon epithelial cells
can become cancerous and develop into colorectal cancer. The spread of tumor cells
depends on the prior activation of the stroma with transforming growth factor-beta. In
addition to the epithelial cells in the colon functioning the important role is played by the
stromal-vascular component that creates the optimal microenvironment both in normal and
in various pathologies, such as colorectal cancer.
Colorectal cancer (CRC) - diagnosis which is often revealed at late stages when
tumor cells havealready disseminated. Current therapies are poorly effective for metastatic
disease, the main cause of death in CRC. Despite the microenvironment importance for a
tumor and progressing metastasis, clinical practice remains predominantly focused on
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targeting the epithelial part. Because CRCs remain largely refractory to current therapies,
scientists must develop alternative strategies. Transforming growth factor (TGF)-b has
emerged as a key architect of the
microenvironment in poor-prognosis cancers. Disseminated tumor cells show a strong
dependency on a TGF-b-activated stroma during the establishment and subsequent
expansion of metastasis. Daniele V.F. Tauriello and Eduard Batlle review and discuss the
development of integrated approaches focused on the treatment of microenvironment
during poor-prognosis of CRCs. Using the microenvironment cells of tumor as a
therapeutic target, is an important milestone for modern oncology.
THE 1st TYPE OF ALLERGIC REACTIONS
Denishchik K., Sun A. – the 3-rd year students
Scientific leaders - Cand.Med.Sc. Matytsin A.P., Kostina V.V.
The term "allergy" was proposed in 1906 by the Austrian pathologist and pediatrician
Clemens Pirke to determine the state of altered reactivity, which he observed in children
with serum sickness and infectious diseases.
So an allergy - it is a typical immunopathological process developing in contact with
the antigen, and is accompanied by damage to the structure and function of its own cells,
tissues and organs. Substances that cause an allergy, called allergens. Allergic reactions,
which are formed by first type immune damage, called atopic.
I. Stage of immune responses. Normally, the human body is tolerant to environmental
allergens. Individuals with the presence of specific molecular anomalies of the immune
system under positive receipt of a number of substances in the body develops an active
immune response - (sensitization) to allergens.Memory B cells when re-entering the body,
cause significant allergen provide express (within 10-20 min), the answer to it, which
corresponds to the following stages of the pathological process. The sensitization is not
only regulated by the Th2 cytokine profile, but also by the appropriate costimulatory
molecules.
II. Stage of biochemical reactions. In this stage, the main role is played by the mast
cells and blood basophils. Mast cells (tissue basophils) - a connective tissue cells. They are
found mainly in the skin, respiratory tract, in the ways of blood vessels and nerve
fibers.Neutrophils and eosinophils are activated and also release biologically active agents,
and enzymes.
III. Stage of clinical manifestations.As a result of the action of mediators there is
increased microvascular permeability, which is accompanied by the development of edema
and serous inflammation.
All of these effects are clinically manifested as attacks of asthma, rhinitis,
conjunctivitis, urticaria (redness and blistering), skin itching, local edema, diarrhea, and
others. The allergy of the first typeis accompanied by increasing the number of eosinophils
in the blood, sputum, serous exudate.
CAROTID ENDARTERECTOMY IN SURGICAL PRACTICE
Prygunov V. - 3-rd year student
Scientific leaders – Doc.Med.Sc. A.P.Saharyuk, E.A.Volosenkova
Carotid endarterectomy - is a surgery aimed at removing the inner wall of the carotid
artery, damaged with atherosclerotic plaque in narrowing and destructing arteries. The
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result of the operation is the restoration of the blood flow in the carotid artery. Carotid
disease is a serious disease. With increased pressure plaques can break off from the walls
of the arteries. They are carried away by the current of blood and clog the blood vessels of
the brain, thereby disrupting the blood supply to certain areas of the brain. In this case
ischemic stroke develops. One of the methods of treatment in this case is the operation
carotid endarterectomy. It is relatively safe and has a long lasting effect. The operation is
performed under a general or local anesthesia. Before surgery neck shaving is performed
to prevent infectious complications. After anesthesia, the surgeon makes a small incision
along one of the sides of the neck. Carotid artery is isolated. The surgeon grasps it to stop
blood flow through it. At this time, the brain receives blood through the carotid artery on
the other side. Alternatively, at the time of surgery, the surgeon may install the shunt to
bypass the affected area of the carotid artery with the purpose of cerebral blood supply.
After separation and compression of the carotid artery, the surgeon makes the incision just
above the constriction. Then the surgeon cleans the existing atheromatous plaques by
scraping the inner wall of the carotid artery. Next, an incision in the artery is sutured and
blood flow is restored. Sometimes, in order to expand the lumen of the artery a small
"patch" is set which can be made from either the patient's own vein taken from the lower
limb, or of synthetic material. Then sutured wound on the neck is sutured. A sterile bandage
is applied. The duration of the operation is approximately 2 hours. This operation is the
"gold standard" in the treatment of carotid stenosis.
BIOINFORMATICS - BIOLOGICAL SCIENCE OF THE 21st CENTURY
Barannikov S. – the 3rd-year student, Beznutrov Y., Vasiliev Y., Stanishevsky S.,
Umarova N., Kherel Ch., Chernikova P., Konev A. – the 2nd-year students
Scientific leader - prof. E.A. Borodin
The term "Bioinformatics" was first used by Paulien Hogeweg in relation to the
study of information processes in biotic systems in 1970. Bioinformatics is an integral part
of the triad of new biological sciences, including genomics, proteomics and bioinformatics.
Bioinformatics is based on the use of personal computers to store and process the
information obtained in the course of sequencing the genomes of living organisms. The
main target of bioinformatics is nucleic acids and proteins, as compounds that store and
implement genetic information.
Typical problems of Bioinformatics are the following: storing information about
the primary structure of the gene (i.e. nucleic acids) and proteins, carrying multiple, local
and global alignment of sequences of genes and proteins and searching for their homologs,
prediction 3D structure and function of proteins based on their primary structure, modeling
of protein-protein and protein-ligand interactions (docking algorithms), a high-precision
image analysis, computational evolutionary biology, and computer-aided design of drugs.
The latter uses computational chemistry methods to create, improve efficiency and study
the mechanism of action of drugs. The first drug created using computer-aided design,
carbonic anhydrase inhibitor is dorzolamide, registered in 1995. Another striking example
of the effectiveness of the use of computer design was the creation of the firm “Novartis”
(Switzerland), the drug imatinib (Gleevec) - tyrosine kinase inhibitor (TKI) of the new
generation. The drug has proved itself as an effective tool in the treatment of myeloid
leukemia and some tumors. The difference of the drug from its predecessors is the ability
to differentially affect the malignantly transformed cells and not to affect the normal
rapidly dividing cells. At the Department of Biochemistry of the Amur SMA
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bioinformatics methods were used to develop a new drug serine protease inhibitor-based
on a soybean trypsin inhibitor. The use of “in silico” (local amino acid sequence alignment)
revealed a certain proximity of the primary structures of soybean and pancreatic trypsin
inhibitors (aprotinin, the active principle of a pharmaceutical preparation Gordoks,
Contrycal) and allowed us to predict the plant inhibitor's ability to influence the hemostasis
process that had been confirmed in experiments “in vitro”. An important advantage of
bioinformatics, in comparison with traditional methods of biology, is the almost complete
absence of necessity of bioinformatics research financing. All you need is a certain level
of knowledge in the field of molecular biology, English language and most importantly to
have the skills to use personal computers to work with scientific electronic databases and
to be able to master the appropriate software.
The aim of our work was to get skills of bioinformatics work on the servers of the
American Center for Bioinformatic Information (Database Proteins), the European
Bioinformatic Institute, the Swiss Institute of Bioinformatics and protein bioinformatic
resource (kontsorsium UniProt). In our research, we have attempted to clarify the
phylogenetic differences in a number of proteins of animal and vegetable origin, especially
of proteins performing similar functions in the body.
TRP ION CHANNELS AS A POTENTIAL TARGETS FOR TREATMENT OF
NEURODEGENERATIVE DISEASES. BIOINFORMATIC STUDY
Borodin P. – the 6th year student
Scientific leader - doct. med. sc., ass. prof. Karnaukh V.N.
The transient receptor potential (TRP) family is a diverse group of channels that
regulates cation entry and contributes to a vast variety of physiological conditions. There
are 28 mammalian TRPs, divided into 6 subfamilies based on homology: canonical
(TRPC1-7), vanilloid (TRPV1-6), melastatin (TRPM1-8), ankyrin (TRPA1), polycystin
(TRPP1-3) and mucolipin (TRPML1-3). All six members share a common structure of
six transmembrane domains with a hydrophobic pore located between the fifth and sixth
domains. Situated in the plasma membrane, TRP channels serve as polymodal integrators
due to their activation by a variety of stimuli including temperature, osmolality,
mechanical force, chemoattractants and ischemia. [1]
TRPs are widely distributed in the central nervous system, with almost every TRP
subfamilies being represented. The most of them are present in the cerebral cortex,
hippocampus, cerebellum, and amygdala. In the peripheral nervous system, TRPs are
highly expressed in dorsal root ganglion cells and primary sensory afferents, where they
are involved in thermal and mechanical nociception.
The basic properties of the nervous tissue are:

excitability (generation of the action potential),

propagation of the action potential,

termination of the action potential.
Action potential is generated and spread along the nerve fiber through the Na+, K+
and Ca2+ ions flow into and outside the cell. TRPs are the channels for Ca2+, so they are
closely associated with the nervous system functioning.
Ca2+ flow through the membrane is associated with cell physiology, including
gene expression, cell cycle regulation and cell proliferation. Increasing of the TRP
expression leads to the Ca2+ flow acceleration. However, the intracellular overload of
Ca2+ leads to the cell death due do the oxidation of membrane lipids by reactive oxygen
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species (ROS). Because of that, Ca2+ is called “killer ion”. Thus, preventing of Ca2+
overload is important for neuronal cells protection.
Reactive oxygen species (ROS) - hydroxyl radical (•OH), hydrogen peroxide
(H2O2), superoxide radical (•O2-) – damage proteins, lipids and nuclear acids. The brain is
one of organs especially vulnerable to the effects of ROS because of its high oxygen
demand. Oxidative stress plays a central role in a common pathophysiology of
neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease.
A potential role for TRPM2 and TRPM7 has been demonstrated in the
development of Alzheimer’s and Parkinson’s diseases. Expression of the TRPM2 and
TRPM7 results in anoxic neuronal damage in ischemic conditions due to the
development of oxidative stress, while the inhibition of expression protects cells. [2]
Within the TRPV family, TRPV1 and TRPV4 are activated in ischemic conditions
and contribute to ischemia-induced depolarization in hippocampal cells, intracellular
Ca2+ accumulation and cell swelling. The injection of hydroperoxides of
eicosatetraenoic acid triggers TRPV1-mediated microglial cell death in the substantia
nigra in vivo. On the contrary, co-injection of the TRPV1 antagonist capsazepine (red
pepper) prevented the cell loss (Kim S.R. et al, 2008) [3]
TRPC1, TRPC4, and TRPC5 are presented in the cerebral cortex, hippocampus,
cerebellum, and amygdala. TRPC1 overexpression contributes to the dopaminergic
neuronal survival in the experimental models of Parkinson disease (Selvaraj S. et al.,
2009) In the experimental models of Parkinson disease decreasing of TRPC1 function
makes the cells more vulnerable to apoptosis, but overexpression of TRPC1 shows
increased cell protection by preventing loss of mitochondrial membrane potential. [4]
To understand the role of TRP in the human body and in the pathogenesis of
neudegeneratve diseases it seems reasonable to find information on the primary structure
of TRP structures in protein databases, perform total and local alignments for the primary
sequences, search for their homologues, predict the 3D structures and functions.
In the current study, we made our try to characterize TRPC1, TRPC4, TRPC5,
TRPM7, TRPV1, TRPV2, TRPV3, TRPV4 as they are the most wide-spread in the
tissues of CNS. We used UniProt http://www.uniprot.org/ and NCBI Protein
http://www.ncbi.nlm.nih.gov/protein databases to find primary structures, active sites or
reactive bonds, functional activities, as well as for performing multiple and global
pairwise alignment of the primary structures of TRP receptors compared with each other.
To perform local alignment and identify library sequences that resemble the query
sequence by comparing a query sequence with a library or database of sequences we used
UniProt BLAST algorithm.
We found 3-D structures of TRPV1 and TRPV2 in RCSB PDB
http://www.rcsb.org/pdb/home/home.do and aligned them with a help of RCSB PDB
Protein Comparison Tool in offline. For other TRP receptors we created 3D structures in
SWISS-MODEL modelling server https://swissmodel.expasy.org/ based on the known
templates.
It was found that TRPs which are associated with the Ca2+-induced cell death have
a similar structure (identity: 10% and similarity: 24% in the align of the tertiary structures
of TRPV1 and TRPM7). On the contrary, TRPC1 is associated with the neuronal
protection, and identity and similarity in the align of the tertiary structures of TRPC1 and
TRPV1 is quite lower (identity: 3% and similarity: 14%).
It is concluded that studies have revealed that modulation of TRP channels could
provide novel treatment approaches for diseases which are at present, poorly controlled.
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If this possibility translates into new therapies, it would provide considerable benefit for a
large population of patients with unmet medical needs.
References
1.
Kauer J.A., Gibson H.E. Hot flash: TRPV channels in the brain. Trends in
neurosciences. Vol. 32, N.4., 2009, pp. 215-224. doi:10.1016/j.tins.2008.12.006
2.
Aarts M., Lihara K. et al. A Key Role for TRPM7 Channels in Anoxic Neuronal
Death. Cell, Vol. 115, 2003, pp. 863–877
3.
K.W. Ho, N.J. Ward, and D.J. Calkins. “TRPV1: a stress response protein in the
central nervous system”, American Journal of Neurodegenerative Disease, vol.1, no.1,
pp.1–14, 2012.
4.
Selvaraj S. et al. TRPC1 inhibits apoptotic cell degeneration induced by
dopaminergic neurotoxin MPTP/MPP+. Cell Calcium. 2009 September ; 46(3): 209–218.
doi: 10.1016/j.ceca.2009.07.008.
SLEEP FOR A STUDENT: A DREAM OR REALITY?
Konev A. – the 2nd-year student
Scientific leader - I.V. Siyanova, Ph.D
Every day, after work, each of us feels the irresistible need to take a horizontal
position, relax and sleep. Almost a third of our lives we spend in this state - in the dream
state. Daily physiological sleep, as well as food is a basic need of the body.
Prolonged sleep deprivation is distressing to a person. Reduced rate of mental
reactions, decreases mental capacity, fatigue quickly sets.
Sleep duration is changed with age. The following needs for sleep for people of different
age groups were established: up to 1 year - 16 hours; 5 years - 12 hours; 12 years - 10
hours; 17 and older - 8 hours.
These well-known rules are not followed by students. As a result livid rings under the
students` eyes, lassitude, twitching eyelids - all this has become almost a norm for students
of AmurSMA.
The purpose of my work is to conduct a survey among the 2nd-year students of
AmurSMA and determine their quality of sleep. The following questions were asked: How
many hours a day do you sleep? Do you sleep during the day? How would you describe
your state of sleep? Do you have enough time for sleep to wake up in the morning and be
ready to learn? 140 students living in hostel 5-6 were interviewed. The results showed that
most students did not get enough sleep, since they slept few hours. Many students
underestimate the importance of sleep. For some students there is a stereotype that it can
not be otherwise in a medical study. However, there are those students who are able to get
enough sleep and have time to learn efficiently and perform all scheduled. I want to
introduce all students of AmurSMA with their secrets as well as the advice of experts in
the matter of sleep.
Tips for falling asleep:
Do not drink coffee before going to bed; it disturbs to fall asleep quickly.
Nicotine is a strong stimulant as well. Make sure to have your last cigarette smoked less
than 3-4 hours before bedtime.
Just make sure, that your stomach wouldn’t cry out for help, it is difficult to fall asleep
quickly when it is empty and asks to eat.
To go to sleep quickly, you should remove any other external stimuli.
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STEM CELLS AND THEIR USE
Mongush A., Konev A. – the 2nd-year students
Scientific leader - Cand.Biol.Sc. T.L. Ogorodnikova
The development of new technologies in medicine, studies conducted in leading
medical centers around the world will shape the future development of medicine for
decades to come. One of the most impressive directions is the use of cellular technologies.
To update the cellular composition of the damaged body without surgery, to solve
the most complicated challenges that were previously solved only by organ transplantation
- these problems are solved today by using stem cells.
For patients it is a chance to start a new life. The important point here is that the use
of the stem cell technology is available for virtually every patient and gives truly amazing
results.
Stem cells are capable of transforming, depending on the surrounding cells, into
tissues of various organs. One stem cell gives many active functional descendants. There
are many diseases that are almost not cured or their treatment is not effective with the use
of medicamental method. Such diseases have been the object of close attention of
researchers.
Everyone has stem cells. They were found primarily in the bone marrow. It is easy
to discover stem cells in young people and children. In the aged, they are in a smaller
quantity. A secret of stem cells is that they can become any cell in the body. Once the stem
cells receive a signal about the tissue damage of any organ, they leave for the lesion. There
they turn into those tissue cells or organs, which need to be protected. They are able to
develop all types of cells: the cells of liver, nerves, smooth muscles, mucous membranes.
An adult has a very small amount of stem cells. Therefore, the older an individual,
the more difficult the process of regeneration and recovery of the body happen.
For the first time it is possible to treat such serious diseases as cirrhosis, diabetes,
stroke, using stem cells. Their source in the body is the bone marrow. In the developed
countries, there are special institutions (banks) for the storage of the stem cells frozen over
time. In such a blood bank a newborn baby’s umbilical cord blood may be placed, so that
in case of injury, illness a baby can have an opportunity to use its own cells. Some forms
of leukemias as well as such diseases as arthritis, multiple sclerosis, lupus erythematosus
became treatable due to the use of these cells.
The list of diseases in which stem cells are used is very diverse and includes benign
tumors (adrenoleukodystrophy, anemia, osteoporosis, a Gunther`s disease etc.) and
malignancies (leukemia, breast cancer, neuroblastoma and others).
With the help of stem cells it is possible to significantly improve skin elasticity,
relieve a person from eczema and dermatitis. Wrinkles, spots after acne will disappear.
Hair and nails have a healthy look, their growth is restored.
Perhaps fantastic ideas about the synthesis of human organs and human immortality
will ever become a reality.
EVALUATION OF EFFICIENCY OF DIHYDROQUERCETINUM IN BURNS
TREATMENT
Leonov D., Mityakin M. - the 1st -year students
Scientific leaders – N.P. Krasavina, Cand.Ped.Sc. I.A. Bibik
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A burn is damage to body tissues caused by the action of high temperature or by the action
of certain chemicals (alkalis, acids, salts, heavy metals, etc.). There are 4 degrees of burns:
first-degree burn - epidermal tissue damage,
second-degree burn - damage of the epidermis, dermis and the papillary dermis,
third-degree burn - damage of the epidermis, dermis and the papillary dermis,
fourth-degree burn – damage of the subcutaneous tissue, muscles, bones.
Dihydroquercetinum is a main flavonoid compound of the Siberian and Dahurian larch.
This substance has high biological activity; also it has many positive effects on metabolic
reactions and the dynamics of the various pathological processes. They are:
1) anti-oxidant action,
2) anti-edema action,
3) hepatoprotective action,
4) antineoplastic action,
5) lipid-lowering action,
6) radioprotective action.
During the experiment animals were divided into two groups - experimental and control.
In this experiment a thermal burn of 250 ° performed with a soldering station after
anesthesia for experimental animals was simulated in both groups.
A gelatin pellicle with dihydroquercetinum was applied directly to the burn. Pellicle
fixation was achieved by the use of Bioglue B-6 and a dry sterile dressing as well as a
narrow medical plaster.
Thus, after the experiment on the rats recovery was revealed in 1.5-2 months for the
experimental group, and in 2-3 months for the control group. On that basis we conclude
that the time of healing of the third-degree burns with a gelatin pellicle with
dihydroquercetinum is reduced by 1.5 – 2 times.
HOMO SAPIENS AFTER A HALF A MILLION YEARS
Gasanova Ch. - the 2nd-year student
Scientific leader – L.G. Zherepa, Cand.Ped.Sc. I.A. Bibik
Most morphologists never doubt that evolutionary changes occur in real time and
will continue in the future. One of the most difficult questions in this case is how human
appearance will change in the course of further evolution.
Many anatomists and anthropologists who study the theory of "a man of the future",
pay great attention to the structure of human body.
As to anatomists, they believe that “ … the human body is not immutable, complete,
and it is just one of the last stages of its development; changes, which occurred in it,
proceed so slowly that they are not accessible to our direct observation, and a variety of
abnormalities and deformities as milestones indicate the ways of its evolution " (ND
Bushmahin, 1913). Based on this theoretical position and doing a detailed description of
various "progressive anomalies" of individual parts of the human skeleton for many years,
anatomists tried to characterize the appearance of a distant future man.
Thus, this report proposes a closer look at: which changes will occur with some
structures of the human body and which "portrait" will have a Future Human.
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FOOT AS A UNIT. THE ARCH OF THE FOOT. ASSESSMENT OF SHTRITER
INDEX IN THE 2nd-YEAR STUDENTS OF AMUR SMA
Mayorova A., Sulitseva E. – the 1st-year students
Scientific leaders – L.G. Zherepa, Cand.Ped.Sc. I.A. Bibik
Foot is a distal department of the lower extremities. It is anatomically and functionally
complex and it is an important organ of support and movement. A lot of bones and joints
forming the foot, the arched structure allow it to perform also spring and balancing
function.
In the common structure of foot five longitudinal arches and one transverse are
distinguished. The longitudinal arches begin from one point of a calcaneus and then divide
forwards along the concave downwards radiuses corresponding to five metatarsal bones.
The longest and the highest of the longitudinal arches is the second. The longitudinal arches
in the forepart connected in the form of parabola form the transversal arch of foot. It is
formed at the level of high points of the metatarsal bones. All arches are strengthened by
ligaments and muscles. When the ligaments are weakened the arch falls, the foot is
flattened and can get a wrong structure called “flatfoot”.
Functional abnormalities, both without change, and with change of a structure cause
changes in all locomotor apparatus, statics and kinetics of a man that lead to work
decrement.
To recognize platypodia in the students of the 2nd-year of Amur SMA the indications of
Shriter index from morphological passports which they fill in during the I and II semesters
were analysed. The data of 40 girls and 40 young men were studied. Among 40 girls 24
individials have a normal arch of foot which amounts 60%, and a flattened foot arch
(i.e.revealed platypodia) in 16 which amounts 40%. Among 40 young man18 individuals
have a normal arch of foot which amounts 45%, and 22 students have a flattened arch
which amounts 55%.
It stands to reason that the predominance of flatfoot is in young men, i.e. there is platypodia.
40% of girls have platypodia - it is a high rate too.
As for prophylaxis of platypodia, serious attention is paid to footwear and foot walk. Fitting
tightly and too loose footwear is harmful. Low heels and high backs at boots and shoes,
flexible outsoles are important for feet to spring. It is impossible to walk constantly in flatsoled footwear and especially in thin-soled footwear. Big weight also leads to soles
"sprawling". Foot walk in the correct footwear strengthens the ligaments of foot and
prevents development of platypodia, and also it is necessary to manage weight.
SCREENING METHODS OF INVESTIGATION AS THE BASE OF
PREVENTION OF DIABETES MELLITUS
Kozhechenkov K., Mikhailov P – the 5th-year students
Scientific leader – Prof., Doc.Med.Sc. L.N. Voit
Diabetes mellitus (DM) is one of the most serious medicosocial and economic health
problems all over the world. Currently, diabetes mellitus (DM) is ranked third among the
direct causes of death after cardiovascular diseases and cancer. That’s why many issues
associated with this disease, are delivered to the state, at the federal level in many countries
of the world. Modern level of diagnostic tools, new means of monitoring of blood glucose,
the introduction of innovative insulins and hypoglycemic drugs, the development of high14
tech methods of treatment can significantly change the situation of the patients prognosis,
reducing the incidence, disablement and mortality due to chronic complications in diabetes.
Maintaining of the risk factors target control, such as blood glucose and unhealthy
lifestyle, is still the most perspective direction in preventing the development and
progression of diabetes. An indispensable condition for the effective control of diabetes is
the creation of active screening programs to maximize early detection of complications,
and optimal organization of clinical and diagnostic process of a multidisciplinary approach
to treatment.
The article presents an analysis of the survey and the screening of rapid diagnosis
of peripheral blood glucose levels in 785 people aged over 18 years, which were held under
the Preventive event to promote healthy lifestyles, timed to coincide with World Health
Day "Be healthy!". The basis of conducted survey is to identify the awareness of diabetes
among the Blagoveschensk population, namely about which factors can cause the
development of diabetes, and about the consequences of this complex medicosocial
disorder.
GENERAL PROVISIONS OF SUMMER TRAINEESHIP IN CHINA
Kozhechenkov K., Mikhailov P. – the 5th-year students
Scientific leader – M.D. I.V. Kostrova
Thankfully, our friends from Heilongjiang University of non-traditional medicine are
providing a unique chance of taking summer practice there in their University.
We, as a small group of 10 students of 4th and 5th years of education went there to take our
practical traineeship, which was, of course really challenging, coz it’s the other country,
the other world in some aspects even. And, surely, completely different approach to
healthcare, which means different hospital organization, different treatment methods and
so on.
We were having studies for almost 3 weeks in 3 departments that we were supposed to take
our practice basically, this is of course surgery, therapy and obstetrics and gynecology,
based on 1st Harbin hospital. So we were divided in different groups, going to different
departments for few days and then switching.
Mainly it was all about the exploring techniques and methods of treatment of most common
diseases and how much those are differ from ours. We were living in quiet lovely hostel
for foreign students. There also were large amount of students from different courtiers that
came there for a short duration for scientific or professional traineeship and for a full study
program as well.
I definitely should notice that the city is developing really fast, there are lots of worth
visiting places, so a cultural program can be intensive, which is always good, we never had
time to be bored with it.
So the main positive reasons to take part in this program: this is almost perfect possibility
to test yourself, to learn something new, to improve your English skills, learn lot’s of
medicine and how it’s being done in different country, and, of course, it’s quite interesting
touristic trip.
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THE RESULTS OF THE «HEALTH FAIR» PROJECT HELD AMONG
SCHOOLCHIDREN OF THE 9th – 11th CLASSES OF EDUCATIONAL
INSTITUTIONS OF BLAGOVESHCHENSK AND AMUR REGIONS BY THE
STUDENTS OF THE AMUR SMA
Elkina A., Koryukova T. – the 5th year students.
Scientific leaders - E.A. Sundukova, N.A. Subacheva
The aim of our scientific work was to identify bad habits, particularly smoking, among
schoolchildren. 3240 participants from 18 educational intuitions of Blagoveshchensk and
Amur regions were underwent an anonymous questionnaire which was consisted of 10
questions.
Our finding were based on conducted questionnaire data for 2014 and 2015.
1.The number of smoking students less than one year was increased, while smoking
students more than a year were declined.
2. In most cases, students begin to smoke because of the "bad company".
3.The most part of parents, of smoking children are aware that their children smoke.
4. All respondents are aware of the dangers of smoking.
5.The number of smokers who want to get rid of smoking in 2015 was increased, compared
to 2014 year.
This suggests that the project "Health Fair" was not missed by the children, and they
make the conclusion for themselves about the dangers of smoking.
ANALYSIS OF CLINICAL EXAMINATION OF PATIENTS WITH CHRONIC
NONINFECTIOUS DISEASES IN THE CITY POLYCLINIC № 2 FOR THE
PERIOD SINCE 2013 TO 2015
Labunko T., Cherednichenko O., Mehedova M. - the 6th year students
Scientific leaders - Cand. Med. Sc. O. M. Goncharova., N.A. Subacheva
It is known that clinical examination is an important tool for the detection and
prevention of noninfectious chronic diseases and their risk factors. It is a system of
measures which are aimed at the prevention of public health; prevention of the disease;
reduction of the frequency of exacerbations of chronic diseases, morbidity, disability and
mortality; and improvement of the life quality.
The aim of this scientific research is the analysis of clinical examinations of
population with chronic noninfectious diseases in the city Polyclinic № 2 for the period
since 2013 to 2015.
Our research is based on the annual reports of the clinical examinations, provided
by the statistics department of the city Policlinic № 2.
A SET OF CLASSIFICATIONS OF PERSONAL FRUSTRATION
Guseinli G. - the 6th year student
Scientific leaders - Brash N.Q., Subacheva N.A.
In our scientific report we touched on the set of classifications of personal frustrations:
-paranoid frustration of the personality;
-schizoid frustration of the personality;
-disocial frustration of the personality;
-hysterical frustration of the personality;
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-obssesiv-compulsiv frustration of the personality;
-disturbing (evading,avoiding) frustration of the personality;
-narcissistic frustration of the personality.
TUBERCULOSIS OF BONES AND JOINTS
Guseinli G.- the 6th year student
Scientific leaders - Karakulova O.A., Subacheva N.A.
According to localization we distinguish the types of osteal and joint tuberculosis,
symptoms of tuberculosis of bones, means and ways of diagnostictics of tuberculosis of
bones, x-ray Patten, laboratory methods of research and of course the treatment of
tuberculosis of bones.
Depending on localization the following types of osteal and joint tuberculosis are
distinguished:
• Tubercular spondylitis (backbone);
• Tubercular drives (knee joints);
• Tubercular coxitis (hip joints);
• Tubercular omarthritis (shoulder joints);
• Tubercular olenitis (elbow joints);
• Tuberculosis of ankle joints and bones of foot;
• Tuberculosis of radiocarpal joints;
• Tuberculosis of tubular bones.
PARROT DISEASE – PSITTACOSIS (ORNITOSIS)
Nogai V. – the 5-th year student
Scientific leaders – Soldatkin P.K., Subacheva N.A.
The first cases of parrot disease known as PSITTACOSIS was described by Urgenson in
1876. He was the first scientist who found and described this disease, when he observed
sick people with atypical pneumonia who had contact with parrots. Morang in 1895
offered to call this disease – psittacosis (from latin «psittae» - parrot). Later the
descriptions of episodes of human infection from, seagulls, sparrows, hens, ducks,
turkeys were appeared. In 1942 Mayer called the disease which was appeared from the
contact with birds not parrots but ornithosis (from the latin «ornis» - bird). In 1930
Levinthal, Koles, Lilly found and described infectious species of birds. This pathology is
a pressing problem because people frequent have contact with birds in manufacturing, in
the city sometimes at home. So it is very important to diagnose timely the symptoms of
the disease in people and sick birds and to take preventive measures to prevent infection.
SEVERE FORMS OF HEMORRHAGIC FEVER WITH RENAL SYNDROME:
CURRENT, OUTCOMES
Vinohodova A., Koryukova T. – the 5th year students.
Scientific leaders - A.V. Gavrilov, N.A. Subacheva
48 % of patient wits severe course of HFRS disease with marked development of
hemorrhagic syndrome and acute renal failue were revealed in the upper Amur region.
The main foci are located in the southern agriculture areas of region and in winters
they communicate with the foci of HFRS, located in the northern China. There is a need
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in rapid assessment of the disease, prediction of outcomes and possible evacuation to the
regional centers.
Our study touches on the problems of severe forms of hemorrhagic fever with renal
syndrome in people of the upper Amur region.
Our study revealed that in the focus of the disease in the far Eas ( Amur region) the
disease has more sever forms that in European part of Russia (Volga region).
It depends on the untimely address it the medicae centres for medicae help.
CASE OF EARLY MANIFESTATION OF THE CHARCOT-MARIE-TUTA
DISEASE
Ahremenko A. Ostanina A. - the 5th year students
Scientific leaders - Chupac E.L., Subacheva N.A.
The Charcot-Marie-Tuta disease is a large group of hereditary diseases of the
nervous system which is characterized by chronic, progressive weakness and atrophy of
distal limb muscles, reduction of tendon reflexes, foot and brushes deformitions, change
of gait and sensory impairments. The degeneration of motor and sensory peripheral nerve
fibers is the base of the disease. Manifestation of symptoms are often observed in the
second decade of life. Mostly an autosomal type pattern of inheritance is predominated.
A boy of 1 year 8 months years old complaining of the rough delay of static-motor
development was under our observation. Full examination of the child was conducted and
Charcot-Marie-Tuta diagnose was made.
The interest of our observation was not just that the disease had its debut at an early
age, but also in the fact that its development was associated with the presence of newly
arisen mutations in the gene of the child for the detection of which a for the defection of
which a required exometric sequentration was conducted.
FOLATE CYCLE VIOLATION DURING PREGNANCY
Eroputko S., Mirgyan M. – the 4th-year students
Scientific leaders - Cand.Med.Sc. Zaritskaya E.N., Kostina V.V.
In the first 12 weeks folic acid is responsible for the correct formation of the fetus
neural tube. Folic acid deficiency causes congenital malformations of the fetus and the
sulfur amino acid metabolism is disturbed and there is a delay amino acid homocysteine in
the blood. Due to the decreased activity of the folate cycle enzymes, which are responsible
for the conversion of folic acid (MTHFR, MTRR, MTR) there is an accumulation of
homocysteine in the body that can stimulate the formation of blood clots. This leads to
abortion, premature placental abruption, preeclampsia and chronic fetal hypoxia. It is
necessary to add on the earlier timing of folic acid in the diet, it helps reduce the risk of
complications during pregnancy, especially it is necessary in the presence of
hyperhomocysteinemia.
ANALYSIS OF THE FREQUENCY OF THE CONGENITAL MALFORMATIONS
ACCORDING TO THE DATA OF THE REGIONAL PERINATAL CENTER IN
2009-2015
Saaya L., Alieva.A. - the 5-th year students
Scientific leaders - Can.Med.Sc. E.N. Zaritskaya, N.A. Subacheva.
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Congenital malformations can be defined as structural or functional abnormalities that
occur during fetal development and can be detected before birth, during birth or later in
life. Studies of CM are not only of scientific interest, but also have practical significance
in the structure of causes of infant death and disability.
In the world congenital malformations occur in 5-6 cases per 1,000 live births.
According to the data of the regional perinatal center from 2009 to 2015, there were
diagnosed 712 cases of congenital malformations, which was 9 ‰ of all pregnancies.
The structure of the CMF was distributed as follows:
• the 1st place is occupied by congenital malformations of the nervous system
(anencephaly, encephalocele, hydrocephalus, spinal hernia) -2,62 ‰,
• the 2nd place is occupied by deformations of the musculoskeletal system (reducing
defects limbs, diaphragmatic hernia, omfagotsele, gastroschisis) -1,54 ‰,
• the 3rd place is occupied by chromosomal abnormalities (Down's Syndrome) - 1,42 ‰,
• the 4th place is occupied by cleft lip and palate (cleft palate, cleft lip with or cleft palate)
-1,32 ‰,
• the 5th place is occupied by congenital anomalies of genitals (hypospadias) - 1,01 ‰.
321- malformations incompatible with life, which led to perinatal loss (miscarriage,
stillbirth, abortion) were diagnosed for the period from 2009-2015 There were 391 live
births with malformations.
In the diagnosis of CMF ultrasound methods, karyotyping and non-invasive method
of DNA diagnostics are of great value.
CONGENITAL MALFORMATIONS OF THE FETUS IN THE AMUR REGION
Alieva A., Saaya L. - the 5th year students
Scientific leaders - O.S. Yutkina, N.A. Subacheva.
Congenital malformations can be defined as structural or functional abnormalities that
occur during fetal development and can be detected before birth, during birth or later in
life. Studies of congenital malformations are not only of scientific interest, but also have
practical significance in the structure of causes of infant death and disability. Over the past
six years in the structure of infant mortality and disability in the Amur region vices occupy
the 1-2 places. According to estimates 276,000 children die each year from malformations
during the first 4 weeks of life. Malformations can lead to long-term disability that has a
significant impact on individuals, their families, health systems and society.
The structure of the congenital malformations for the 2009-2015 year:congenital
malformations structure was distributed as follows: the 1st place takes Dauna Syndrome –
15.7%, the 2nd place – person malformations (cleft lip/palate)- 14.6%, the 3d place –
hypospadias and spinal hernia -11.2%, the 4th place hydrocephalus – 11.09%.
A huge role in solving this problem belongs to the prevention of birth defects. By
improving the efficiency of prenatal diagnosis the birth of children with congenital
malformations can be reduced, and accordingly infant mortality and disability due to this
pathology can be also redused.
MELANOMA
Valieva L.A., Ustarhanova N.Sh. - Interns - dermatovenerologists
Scientific leaders - Саn.Med.Sc. Korneeva L.S., Subаchevа N.А.
Melanoma is a disease in which malignant (cancer) cells form in melanocytes (cells that
color the skin).
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Melanoma can occur anywhere on the skin.
Unusual moles, exposure to sunlight, and health history can affect the risk of melanoma.
Signs of melanoma include a change in the way a mole or pigmented area looks.
Tests that examine the skin are used to detect (find) and diagnose melanoma.
Certain factors affect prognosis (chance of recovery) and treatment options.
We considered risk fаctors.
AWARENESS OF STUDENTS OF MEDICAL HIGHER INSTITUTION IN
MATTERS OF CONTRACEPTION
Kiselko N., Kiselko M., Danilov M. – the 5th year students
Scientific leaders – Doc.Med.Sc., Prof. Woight L.N.,Subacheva N.A.
Currently the problem of contraception among young people are very important due to
the last events about created appeal called as“On circulation of citizens to ban abortion”,
that caused us thinking about consequences of this actions in the future and what it can be
lead to. We also did a supposition, that a lot part of young people are deficiency
competent in sexual education, that’s why we created the anonymous survey list, which
included questions of currently information of students of ASMA about methods of
contraception and ways of terminating an unwanted pregnancy (abortion); possible
consequences of abortion and its effect on women's health (the fetus health), with the aim
of further analysis of the gained data and synthesis of the results about the general picture
of this problem in the academy. According to the final results the holding of informative
and educational conversations on the subject of sex education since the puberty (12-15
years of age) can be recommended as measures of preventing of unintended pregnancies
and accurrence of venereal disease.
PREVALENCE OF RENAL REPLACEMENT THERAPIES HEMODIALYSIS IN
THE AMUR REGION
Kulpin D., Yakushova O. - 5th year students.
Scientific leaders - I.V. Kastrova, N.A. Subacheva
Renal replacement therapy (RRT) - is a complex heterogeneous in structure and
principles of the activities carried out to maintain the life of the patient with permanently
lost functions of his own kidneys. In practice, such states are called terminal renal
diseases (TRD) or terminal-stage chronic renal failure (TSCRF). The methods include the
RRT is program hemodialysis (PG), peritoneal dialysis (PD) and kidney transplantation
(KT). To save man from the TRD must be systematically cleansing his blood from toxic
compounds and to ensure removal of excess fluids from the body. For this purpose, there
are effective means and among them - the artificial kidney. The procedure called program
hemodialysis, which takes place in a specialized dialysis centers. However, hemodialysis,
peritoneal dialysis and occupy a significant amount of time due to the fact that we are
talking about short-term artificial replacement of natural body functions operating
continuously throughout life. That is why PG or PD can be considered only as an
intermediate treatment of patients with TSCRF.
CLINICAL CASE NIEMANN-PICK DISEASE
Krivenko A, Gorshkova K. - the 5-th year students
Scientific leaders – Can.Med.Sc. Chupac E.L., Subacheva N.A.
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Niemann-Pick disease (sfingomielolipidoz) - a hereditary disease caused by the
defecte of lysosomal sphingomyelinase, this is due to mutations in the
sfingomielinfosfodiesterazy 1 gene and is characterized by the accumulation of
sphingomyelin in the lysosomes, by the damage of the nervous system and by visceral
organs. The lack of the enzyme blocks the cleavage of sphingomyelin into ceramide and
phosphocholine, which accumulates in the lysosomes of cells of visceral organs
(«foamy» cells), including the brain. SMPD1 gene mapped to 11 chromosome locus lip
15.4-r15.1. Niemann-Pick disease is an autosomal recessive pattern of inheritance.
Approximate frequency - 1: 100,000 births.
Manifestation of disease falls on the early age of the child - from 4 to 6 months.
Symptoms of sluggish baby are anxiety, feeding difficulties, and sometimes nausea,
vomiting, diarrhea, unexplainable temperature rises, respiratory disorders. It is
characterized by an enlarged liver and spleen, jaundice, generalized lymphadenopathy.
There may be spasmodic paroxysms. Gradually, there is a regression of acquired skills,
decreased of interest in the world around them. Children cease to hold his head, sit and
roll over on their own. In the second year of life it is obvious cachexia and growth
retardation. In the terminal stages of the disease there are spasticity, opisthotonus, bulbar
disturbances, absence of tendon reflexes. The lethal outcome is between the 2nd and the
3rd year of life. Effective treatment of the disease has not been developed, and treatment
is symptomatic.
Alexander M., a year and 10 months was admitted to the hospital with complaints
of parents of regress in psychomotor development, frequent tremors, stiffness in the large
joints, the presence of umbilical and inguinal hernias. The boy was born with which the
weight of 3550 g, length 53 cm. Apgar score was 7/8 points. The diagnosis was based on
the following data: a manifestation of the main symptoms of the disease in the first year
of life; rapidly progressive disease; regression of psychomotor development; coarse facial
features; joint stiffness; hepatosplenomegaly; anemia and thrombocytopenia; symptom of
"cherry stone" in the fundus; reduction of sphingomyelinase lysosomal of enzyme
activity in peripheral blood leukocytes. DNA analysis (Molecular Genetics) - SMPD1
gene mutations - deletion of the thymidine at 1198 of the cDNA position. Proband was
assigned to combined therapy with the use of neuroprotective drugs, antioxidants, A, C,
B vitamin complex, broad-spectrum of antibiotics, hepatic.
In the management of patients with suspected disease of Niemann-Pick it is
necessary to take into account the severity of the disease and its early deaths and the
difficulties of differential diagnosis.
LONG-TERM OUTCOMES OF HEMORRHAGIC FEVER WITH RENAL
SYNDROME
Gorshkova K., Krivenko A. the 5th year students
Scientific leaders - A.V. Gavrilov, N.A. Subacheva
The development of the infectious process in hemorrhagic fever with renal syndrome
(HFRS) has complex of mechanisms associated with the direct impact of the virus on the
walls of the small blood vessels of all organs.
Since 1986, under the supervision there were 484 patients with a clinical diagnosis of
HFRS. The observations were made, starting with the acute period of the disease in the
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clinic of infectious diseases of Amur State Medical Academy, Department of Nephrology
of the land the1st, and the 3rd city hospitals, the military hospital.
The analysis allowed to identify a group of patients with severe form of the disease (315
people).
To study the residual long-term effects there were examined 116 convalescents who have
had severe forms of the disease.
Assessing the dynamics of the recovery period in HFRS, taking into account the received
clinical, biochemical and instrumental data there were made the outcomes of this disease.
1. Complete recovery:
a) early reconvalescence (within 6 months);
b) prolonged reconvalescence (for 7 months - 5 years);
2. Residual effects:
a) asthenoneurotic syndrome;
b) lumbar pain syndrome;
c) the tubular renal insufficiency syndrome (interstitial
focal nephrofibrosis);
g) hematological syndrome (neutropenia, lymphocytosis);
d) Dysproteinemia (gipoalbunemiya, hyperglobulinaemia)
3. Secondary urinary tract disease (chronic pyelonephritis).
Results:
1. From the side of the sindrom of tubular fainlare is formed, the decrease of the excretory
capacity of is remaind tubular system is remains for long-time; of tubular failure is formed:
after a severe form of the disease; revealed chronic pyelonephritis and hypertension are
revealed;
2. From the side of the liver changes were manifested in the US in the form of diffuse
manifestations and hepatomegaly. Complaints were presented in a way of dyspeptic
character;
3. From the respiratory system changes during the recovery period were not observed;
4. There are changes in the pituitary gland in the form of the formation of cysts, decrease
the size of the pituitary due to hemorrhage, but not always the pituitary lesion were
irreversible.
The results of the study of the pathology of the internal organs and the nervous system in
patients who have been underwent HFRS indicate the need to organize the monitoring of
convalescents.
PENTASOMYA ON X CHROMOSOME
Vinohodova A., Koryukova T. – the 5th year students.
Scientific leaders - E.L. Chupak, N.A. Subacheva
Cases of X pentasomya are extremely rare. Leading clinical manifestations of
the syndrome are neurodevelopmental delay in combination with somatic microanomalies.
X pentasomya is developed only in female individuals. The cells of our body
usually contains 46 chromosomes, 22 pairs of which are from 1 to 22 plus two sex
chromosomes, X, or Y. Women have two X chromosomes and their chromosome set is
22
known as 46, XX karyotype. But the girls with pentasomya, instead of two, there will be
five X chromosomes and their karyotype is written as 49, XXXXX.
Most likely, that such children have four X chromosomes from the mother and
one from the father. This event, in which four X chromosomes, are remounted from the
mother has its technical name - nondisjunction of chromosomes. And it happens more often
than you can imagine.
The first clinical description of the girl with X pentasomya belongs to N. Kesaree
and P. Wooley. In subsequent years, the world literature has been described in about 20
cases of X pentasomya H.
Because of the rarity of this variant of X polysomya the observation of this
pathology in girl of 6 years old was observed on the basis of a consultative and diagnostic
medical genetic St. Petersburg city center.
In this case, they were able to establish the cause of intellectual defect, caused by
chromosomal imbalance.
CHARITY AS EFFECTIVE HELP TO PERSONS IN NEED
Telyakova A., Semdyankina Y. – the 5th year students
Scientific leaders – Doc.Med.Sc, Prof. L. N.Voight, N.A. Subacheva.
The charitable help in Russia has long traditions. It had a long way of development and
became the base of forming such professional activity as public work.
Charity implies rendering by individuals or the organizations of the free and regular aid
to the needing people.
Activities of the doctor are out of limits of his designated use and the doctor is not only
the eminent public figure, but the participant of charity.
Charity is performed for the purpose of:
- social support and protection of citizens,
- preparation of the population for overcoming consequences of natural disasters, for
prevention of accidents and assistance to victims
- assistance to strengthening of the world, friendship and a consent between the people,
- assistance to strengthening of prestige and role of a family in society;
- activities in the sphere of prevention and protection of public health;
- environmental protection and protection of animals;
The research of the bases of charity plays an important role now. Today there is a revival
not only the charitable help of the state, but also private organizations, and also charity of
separate legal entities. All this promotes rendering more effective help to the needing
people.
LIVER TUMORS IN CHILDREN
Cherednichenko O., Labunko T. – the 6 th -year students.
Scientific leaders - S.N. Nedid., N.A. Subocheva
Actuality. Primary tumors of the liver in children are relatively rare diseases and
constitute up to 3% of all tumors occurring in childhood. The liver is the third-mostcommon region area for intra-abdominal malignancy in children, following
adrenalneuroblastoma and Wilms tumor. Liver cancer takes part from 0.5 to 2% of all
pediatric malignancies and about 5% of abdominal oncology. Among this malignant
tumors, hepatoblastoma (HB) and hepatocellular carcinoma (HCC) are the most common
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tumors and accounts for two thirds of all liver tumors. Benign liver tumors accounts for
30% and are represented by hemangioma, mesenchymal hamartoma, hepatocellular
adenoma, teratoma and focal nodular hyperplasia.
Objective: Analysis of the clinical case.
The aim of this scientific research is the analysis of literature and clinical case.
FEATURES OF DIAGNOSIS OF MALIGNANT MESOTHELIOMA OF PLEURA
Mehedova M., Cherednichenko O. – the 6 th year students.
Scientific leaders - Doc. Med. Sc. V.V. Voicehovsky., N.A. Subocheva
Diffuse malignant mesothelioma – is a malignant tumor of the pleura, it consists of
mesothelial cells and showing diffuse growth on a pleural surface. Mesothelioma more
often affects pleura (57.1%), peritoneum (39.1%), and pericarditis (1%). Malignant pleural
mesothelioma (MPM) – is a rare neoplasm. However, it is the most common primary
malignant tumor of pleura, the incidence of which is always increasing.
Objective: to study the diagnostic features of MPM.
Materials and Methods: Literature analysis.
Clinical and radiological picture of this disease is determined by the degree of
compression of the lung by the tumor, by its germination in the adjacent anatomical
structures, by the amount of fluid in the pleural cavity and the presence of metastases in
other organs and tissues.
CT helps to detect of the diffuse mesothelioma out an early stage the pathological
changes of which are detected in the pleural sheets: the dissemination of tumor on pleura,
its relationship with the tissues of the chest wall, lungs, and mediastinum.
According to the date of literature, the possibilities of MRI and CT in identification
of the stage are limited. This is due to the fact that the spread of this neoplasm is
unpredictable. Most accurately, changes in the pleural cavity might be detected by
thoracoscopy. It helps to detect the tumor early, to determine the extent of its dissemination
and relationship with other organs.
The diagnosis can only be exposed after histological examination of biopsy and
surgical material.
ANALYSIS OF CASES OF IDIOPATHIC PULMONARY HYPERTENSION
ACCORDING ARCH
Melnikova V. - the 6-th year student.
Scientific leaders - Can. Med. Sc. O.N. Sivyakova, Subacheva N.A.
Idiopathic PH - a rare disease of unknown etiology characterized by a marked
increase in pulmonary vascular resistance and pulmonary artery pressure, often progressive
course with the rapid development of the pancreas decompensation and fatal prognosis.
Idiopathic PH is diagnosed at an average pressure in the pulmonary artery 25 mm Hg at
rest and greater than 30 mm Hg. during exercise stress, normal wedge pressure in the
pulmonary artery (10-12 mm Hg. Art.) and the absence of possible causes of PH (heart
disease, lung, recurrent pulmonary embolism, etc.).
Analysis of case historys of patients with IPH of ARCH was conducted in the period
from 2011 to 2016. There were revealed 4 cases of the disease between the ages of 19 to
43 years old: women were dominated -75% (3); fatalities - 50% (2). The family nature of
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the disease was observed in 50% (2) patients, and 75% (3) patients - inhabitants of the city
Belogorsk.
It turned out that the duration of symptoms in patients before diagnosis was from 6
months to 16 years, in the cases of fatal outcome - the median survival from the time of
diagnosis is 9 years, surveys in other clinics and excluded the diagnosis were also revealed.
A comparison analysis of patients history was done and it revealed: smoking, presence of
relatives with a similar pathology, presence of concomitant diseases; physical examination
revealed acrocyanosis, cardiac hump, auscultation data. The characteristic changes in the
clinical and biochemical analysis of blood were determined: polycythemia, increased
transaminases, hyperbilirubinemia, respiratory alkalosis. From instrumental methods ECG,
echocardiography (hypertrophy or overload of the right heart), spirography, CT scan were
studied.
Despite the rarity of this disease, you need to remain aware of idiopathic pulmonary
hypertension in the event of dyspnea of unclear etiology. Physicians of narrow specialties
have no alertness in recognizing of idiopathic pulmonary hypertension, interpretation and
analysis of revealed symptoms are usually completed by local pathology that unduly delay
the preliminary stage of the diagnosis. Patients with suspection on idiopathic pulmonary
hypertension should be sent as soon as possible to the appropriate profile specialists for
individual therapy which is appointed by the severity of the condition, effectiveness of
treatment carried out previously.
FEATURES OF THE HFRS EPIDEMIC PROCESS IN THE REGION OF THE
UPPER AMUR REGION
Saaya L., Alieva A. - the 5th year students
Scientific leaders - A.V. Gavrilov, N.A. Subacheva
Among the diseased people men (67.4%) dominate, women -32,6% in 2 times less.
The most hard-working age are people from 21 years to 50 years old (65.1%).
More than half of all patients are rural people (64.5%). The distribution of patients by
occupation is presented in table №3.
On the territory of the Amur region the centres of HFRS are located in the southern
agricultural areas of the Zeya-Bureya Plains.
22.8% of patients lived in regional centres, and only 6.1% of people lived in city, 6.6% of
people lived in workers' settlements. The predominance of the rural population and a
professional feature of cases are associated with the work and the possible transmission
routes. According to our observation, all patients performed the following kind of work
(Table №4) during 2 months before the illness.
According to our observation: 43.1% of patients indicated the presence of a large
number of house mice and at work, especially in the field under the shocks and the old rolls
of hay and straw. Moreover, 13.3% of the patients only 9.9% of patients cared for HFRS.
It should be noted that 23.4% of patients noted the incidence of the disease in relatives and
neighbors, and 17.9% were from the same village.
ANALYSIS OF ROAD TRAFFIC ACCIDENTS IN AMUR REGION
Krivenko A, Gorshkova K. - the 5th year students
Scientific leaders - Can. Med. Sc. Sundukova EA, Subacheva N.A.
25
In the current socio-economic conditions, there is a high incidence of road traffic
injuries and their adverse effects which have a significant position in the structure of
mortality.
Among the reasons for the death of citizens in Russia - deaths due to external causes,
including road traffic accident (RTA) took the 3rd place and the 2nd place in the Amur
region. According to statistics from Rosstat and Amurstata for 2015 were deaths from were
external causes in Russia is 177 590 people (the 1st place - diseases of cardiovascular
system (930 105 persons), the 2nd place - tumors (300 232 people)), and in the Amur region
from external mortality reasons - 1755 people (the 1st place - diseases of cardiovascular
system (4218 people), the 3rd place - neoplasms (1638 people)).
Traffic accident is an event that occurred during the movement of the vehicle and the
road with its participation, which killed or injured people, damaged vehicles, facilities,
goods or other caused material damage.
The urgency of the problem was confirmed by the statistics of the traffic police in 2014
and 2015, according to which there were 185 540 road accidents in 2014 in Russia in which
24,423 people died and 228,855 were injured. There were 1507 road accidents in the Amur
region in which 168 people died and 1904 were injured. In 2015, Russia registered 184,000
cases of traffic accidents, in which 23 114 people were killed and 231,197 were injured.
As for Amur region, there were 1398 cases, including 152 dead and 1777 wounded.
Consequently, there was positive trend to a decrease in traffic was accidents in 2015
compared to 2014 year. In accordance with the decision of the Russian Government dated
14.11.2014 number 1197 to July 1, 2015 the amendments to the "Russian Rules of the
Road." As the rule came into force, all pedestrians in the dark time obliged to have
reflective elements on clothing that drivers would notice them from a distance.
In order to reduce road traffic injuries there was created a three-tier system for the
provision of medical assistance to victims in the accident (trauma centers), and a routing
scheme of trauma centers of I-III levels was developed.
Thus, in compliance with all rules of road safety as the drivers and pedestrians the
number of accidents may be reduced in future.
THE EXPERIENCE OF LAPAROSCOPIC APPENDECTOMY OF SURGICAL
DEPARTMENT OF THE AMUR REGIONAL CHILDREN'S CLINICAL
HOSPITAL 2011-2015
Pnuykhtin O., Pnuykhtina M. the 6-th year students
Scientific leaders - Nedid S. N., Subacheva N.A.
Acute appendicitis is the most common acute surgical diseases of organs of abdominal
cavity. In acute appendicitis and peritonitis the operation of choice is laparoscopic
appendectomy.
The aim of our work was the analysis of postoperative complications of laparoscopic
appendectomy in the surgical Department.
The most common complication is postoperative infiltration of the abdominal cavity
(3,2%), which is diagnosed according to clinical findings, ultrasound picture on the 5-7
day from the onset of treatment. Among them, the largest number of cases of patients with
uncomplicated forms of acute appendicitis are (n=11), that, most likely, speaks about the
violation of the methodology and the inadequacy of the treatment of the mucosa of the
stump of the Appendix.
Implementation in routine practice of the laparoscopic appendectomy, laparoscopic
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sanation, and drainage of the abdominal cavity in the peritonitis has allowed to reduce the
number of postoperative complications compared to classic operations.
DIAGNOSIS OF CORONARY ARTERY LESIONS IN UNSTABLE
STENOCARDIA
Rogovchenko.A, Archipov S. - the 3rd year students.
Scientific leaders - Doc. Med. Sc., Prof. Menshikova I. G., Subacheva N.A.
Today acute coronary syndrome (ACS) is widely used in emergency cardiology. It
includes acute variants of cardiac ischemia (AVCI)- heart attack and unstable stenocardia.
Cardiovascular diseases are still remained the one of the most basic cause of
mortality, and it negatively influences on demographic situation and socio-economic
indicators of the Russian Federation.
Regional vascular center has been opened and began to function on the base of the
Amur Regional Clinical Hospital and on three primary vascular branches in
Blagoveshensk, Svoboniy, Raichikhinsk since July 2010. In 2015 two primary vascular
branches were opened in Tynda and Zeya.
Coronary angiography and percutaneous coronary angioplasty with stenting of
cardiac ischemia patients have been performing since March 2011. Coronary angiography
and surgical treatment of cardiac ischemia have been carrying out on the base of Cardiac
Surgery Center of the Amur State Medical Academy.
We examined ten patients with unstable stenocardia that were treated in the primary
vascular department of City Clinical Hospital of Blagoveshensk : 8 men, 2 women. The
mean age of patients was 65 years.
All patients got survey: clinical and laboratory. ECG, echocardiography were
registered. Coronary angiography and stenting were performed.
We found single-vessel affection of coronary artery in 4 patients, double-vessel
affection of coronary artery in 4 patients and triple-vessel affection in 2 patients.
All patients got percutaneous coronary angioplasty with stenting. After this
operation mortality is decreased and patients return to their usual life.
HISTORY OF THE DEPARTMENT OF HOSPITAL SURGERY
Alieva A., Saaya L- the 5th year students
Scientific leaders - Prof. V.V. Yanovoy., N.A. Subacheva
Department of the Hospital Surgery of Amur State Medical Academy was founded in
October 16, 1956, when D.M. Sch H.Y. Iosset was elected as a Head of the Department of
Hospital Surgery by the order № 125 of BSMI named that the post of Head of the
Department of Hospital Surgery was appointed MD Herman Y. Iosset as H.Y. Iosset was
born in 1899 in the city of Shiauliai SSR. In 1928 he graduated from the Leningrad Institute
of medical knowledge. For several years he worked as the head of the surgery department
in the city Kutra of Sverdlovsk Region. In 1934, he was invited to the post of assistant to
the department of surgery of the Leningrad Medical Institute, defended his thesis in 4 years.
In 1969 the course of Traumatology, which was headed by Associate Professor Canson
was transformed into an independent chair. In 1952 there was the first graduation of young
doctors - 170 people, 70% of excellent and good ratings on surgery. In the second year of
the department there were already 7 teachers. Scientific direction was defined by Prof. GJ
Iosset.
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Yakimashko O.E for 18 years worked at the department after graduating, the
Khabarovsk Medical Institute in 1947. Her scientific and medical activities were devoted
to the pathology of the thyroid gland in the Amur region, the scientific topic is now widely
studied in many departments of our academy.
The next, the brightest page of the department is connected with the name of Professor
Kulik Y.P. He arrived in Blagoveshchensk in 1968 for the first time. Before it he headed
the cardiovascular department in Smolensk. From 1968 to 1971 he. He headed the
Department of General Surgery of BSMI. In 1967 he organized a research group to develop
a new method of cardiopulmonary bypass with natural oxygenation, and then founded the
"problem research laboratory circulatory support with natural oxygenation." And already
in 1969, it carried on the first heart surgery in the region. Then there were performed 150
operations each year on closed procedure and 120 to AIC. There were received 173
certificates for invention, it should be noted that in his direction the whole bureau, headed
by engineer Mashkonovym worked.
In 1968 he opened a branch of chest surgery. A significant role in the development of
thoracic surgery was devoted Shishlova VI, the pioneer of videotorakain surgery.
One of the main scientific work was the study of Sudakova M.V. It was dedicated to
the development of an artificial ventricle. This ventricle had to replace a natural one at all
critical conditions associated with loss of function of his own heart. In 1995 the reorganized
department was headed by V.V. Janovoy.
CONGENITAL ARVI, COURSE FEATURES
Alieva A. - the 5-th year student
Scientific leaders - P.K Soldatkin., N.A Subacheva.
Congenital acute respiratory viral infections can cause fetal intrauterine lesions that
lead to miscarriage, stillbirth, and the formation of placental pathology. The hard and long
form of the virus infection in a pregnant woman, can be the greater probability of hitting
the fetus, but mild forms of influenza and other acute respiratory viral infections can also
lead to a severe pathology. Intrauterine respiratory viral infections can be arised by
hematogenous path of infection or infection of the fetus as a result of aspiration by amniotic
fluid or through the conjunctiva during childbirth. Infection during embryogenesis (from 3
to 12 weeks.) leads to death of the embryo or the appearance of malformations. Infection
of the fetus after the 12th week of development leads to occurrence of fetopathy.
Intrauterine malnutrition, stigma dizembriogeneza, prematurity, morphofunctional
immaturity, brain damage are revealed in infants wits confirmed congenital respiratory
viral infection.In the infection of the fetus in the last days of pregnancy, the newborn in the
first hours or days after birth clinical symptoms of congenital respiratory viral infection
are revealed. Clinical picture is characterized by the defeat of the respiratory system with
the development of catarrh of the upper respiratory tract and pneumonia;often the brain is
involved,in the pathological process. Generalization of the process contribute antinatal
hypoxia, intranatal asphyxia,and prematurity, fetal immaturity. The reason of deaths
outcomes that occur mainly in the early stages (within first 3 days of life), in most cases,
is a viral-bacterial pneumonia, at least - brain damage.
We also give information about classification of congenital ARVI: congenital flu,
congenital parainfluenza infection, congenital adenoviral infection, congenital respiratory
syncytial infection, congenital viral infection.
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THE ROLE OF SSS IN PROFESSIONAL TRAINING OF FUTURE DOCTORS
Kramarenko A, Dementieva H – the 5th year students
Scientific leaders – Doc. Med. Sc, Prof. Voight L.N, Subacheva N.A.
The acts for many years Student Scientific Society (SSS) - a scientific association of
students of the Amur State Medical Academy takes an active part in social life of our
academy.
This society consists of students who are involved in scientific and research work as well
as young researches from the graduated students. In the early years the number of circle
members was 200 people, and now their number has increased significantly up to 1700
people.
SSS was organized in 1952. Its founder was Professor Kira Alexandrovna
Meshcherskaya and the first chairman – Rodion Petrov, was a student of the 1st course.
During the entire existence of SSS then were replaced not only supervisors but also the
SSS Chairmen. Society was headed by such famous scientists as Meshcherskaya Kira
Alexandrovna, Protasov Vladimir Yakovlevich, Kulik Yaroslav Petrovich, Pavel
Belozerov Tihonovich, Ryzhavsky Boris Yakovlevich, Zavolovskaya Larisa Ivanovna,
Borodina Galina Petrovna.
Such as students Rodion Petrov, Viktor Lifar, George Antimony, Viktor Smirnov,
Vladimir Zhizhin Evgeny Borodin, Vladimir Samohvalov, Marina Savelyeva, Alexey
Barabash, Sergey Tarasyuk, Paul Matytsin Andrew Gritsoun, Sergey Anikin. Were in the
role of the SSS Chairmen.
At present, the position of the supervisor takes the head of the Department of Biochemistry,
Doc. Med. Sc., Prof., Honorary Worker of Higher Professional Education of the Russian
Federation, Yevgeny Borodin, and the position of Chairman of the SSS takes the 6-year
student, excellent students - Melitsky Eugeny.
Being engaged in the scientific circle, students deepen their knowledge not only on the
subject of the circle, but also in related disciplines, develop their creative abilities, broaden
their horizons, learn to speak in public. Working in a circle, students have the opportunity
of scientific training with teachers and with each other outside the classroom.
Scientific work of students are published in the AGMA collections of student research
papers, scientific journals, which are also, in turn, allows students to expand their
capabilities and even closer approach to their future profession.
ENZYMOPATHY. GALACTOSEMIA
Zaitseva O. – the 2nd year student
Scientific leaders – Assoc. Prof., Cand. Biol. Sc. Doroshenko G. K., Kostina V. V.
Galactosemia - a rare genetic disorder of a metabolism at which normal
process of metabolism of a galactose changes. The galactosemia is inherited behind
autosomno-recessive type and arises because of deficiency of activity of enzyme of
galaktozo-1-phosphate. It is characterized by the increased maintenance of a galactose
in blood – a galactosemia and in urine – a galactosuria.
The babies affected with a galactosemia usually have symptoms:
• a lethargy;
• attacks of vomiting, diarrhea;
• retardation of physical development;
• an icterus.
29
The only treatment at a classical galactosemia is strict abstention from the use
of a galactose and lactose. Babies can't eat breast milk and use mixes on the basis of
soy milk.
JAUNDICE (HYPERBILIRUBINEMIA) IN NEWBORNS
Grek N., Chuvakina A. - the 2nd year students
Scientific leaders - Cand. Med. Sc. E.V. Egorshina, V. V. Kostina
Jaundice (hyperbilirubinemia) in newborns — state of children of the first months
of life, when the skin, mucous membranes, whites of the eyes (sclera) turn in yellow. It
occurs due to the increase in the blood special substances, bilirubin. Jaundice is observed
in 65 – 70% of newborns during the first week of life, approximately 10% of cases it is
pathological. The most common is physiological jaundice. The reasons for the increase in
the concentration of bilirubin in the blood after birth. 1. Increased the rate of formation of
bilirubin due to: a)physiological polycythemia; b) shorter life expectancy of the
erythrocytes containing fetal hemoglobin; c) the catabolic orientation of a metabolism
leading to formation of bilirubin from sources which have no erythrocytes (myoglobin,
pirrola, hepatic cytochrome, etc.); 2.Functional ability of a liver on bilirubin removal is
reduced: a) bilirubin capture is reduced by a hepatocyte; b) activity of GTP and other
fermental systems of hepatocytes is reduced (activity of GTP increases by 50% within the
first week, reaching the level of adults only by 1–2 months of life); c) the excretion is
lowered; 3. Repeated intake (recirculation) of indirect bilirubin from intestines in blood is
increased in connection with: a) high activity of enzyme of a β-glucuronidase in intestines;
b) receipt of a part of blood from intestines through venous (Arantsiyev Canal) in the lower
hollow vein, passing a liver; c) transitory disbiocenosis intestines. Classification of
neonatal jaundices - Jaundices: physiological and pathological. - On genesis all jaundices
are subdivided on hereditary and acquired. - According to laboratory data all neonatal
jaundices are divided into two main groups: 1) hyperbilirubinemia with prevalence of
indirect (untied) bilirubin; 2) hyperbilirubinemia with prevalence of direct (connected)
bilirubin.
CHILDREN’S ONCOLOGY IN THE AMUR REGION
Nesterenko T., Demyanenko E., Shikulskiy A. – the 2nd year students
Scientific leaders – Guba L. A., Kostina V. V.
Cancerogenesis processes in children are of great interest from the standpoint of both
clinical and theoretical oncology. Interest in oncology in the Amur region is due to the
growth of disease. We note an increase in the number of patients with primary localizations
of malignant tumors in the last ten years. On average, each year we have a more than 2.5
thousand new patients of which 25% - children. There’s no galloping growth of cancer in
our region during the last five years. Amur region has a below average indices out of the
total cancer incidence. In the Far Eastern Federal District we give almost all regions by
«leadership» , the lower the incidence is only in Chukotka and Yakutia. However, cancer
still remains one of the pandemics. This term is used in the case where the death rates are
the primary cause of demographic losses. The proportion of patients with the fourth stage
remains high, especially since 2015 in the Amur region, the index rose from 23 to 25.3%.
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DETOXIFICATION OF XENOBIOTICS
Nesterenko T., Demyanenko E., Shikulskiy A. – the 2th year students
Scientific leaders – Cand. Med. Sc. Egorshina E.V., Kostina V.V.
Xenobiotics - a substance foreign to the body. Neutralization of most xenobiotics occurs
in two phases:
I – phase of chemical modification;
II - phase of conjugation.
I. Chemical modification - is the process of enzymatic modification of the original
xenobiotic structure, which results in:
- breaking intramolecular bonds;
- joining the molecule additional functional groups (-CH3, -OH, -NH2),
- removal of functional groups by hydrolysis.
The types of modifications:
- Oxidation (microsomal, peroxisome)
- Restoration
- Isomerization
- Acetylation, methylation, hydroxylation
- Hydrolysis etc.
As a result of chemical modification xenobiotics become more hydrophilic, increasing
their solubility and they are excreted in urine. Additional functional groups are necessary
the substance to enter a phase of conjugation.
II. Conjugation - the formation of covalent bonds between the xenobiotic and endogenous
substrate. Formation of links occurs on xenobiotic OH or NH2-group. The resulting
conjugate has low toxicity and is easily excreted from the body in urine.
CAFFEINE AND THEOBROMINE. OUR MISCONCEPTIONS ABOUT COFFEE
Beznutrov Ya. – the 2nd year student
Scientific leaders: Cand. Med. Sc. Doroshenko G.K., Kostina V.V.
Caffeine takes effect immediately and for 20-25 minutes. It has effects: narrows
vessels of all organs except kidney blood vessels, so blood flow improves in all organs,
hence the person feels gord spirits. Theobromine effects are opposite: expands all vessels,
except renal, so - pressure reduction and deterioration of blood flow to the kidneys, and the
person begins to feel uncomfortable pulling sensation in the kidneys and fall asleep.
The worst thing is that people are not aware of these arrangements fall into a very
unpleasant situation: bake for oneself instant coffee, do not receive any cheerfulness, and
after 20-25 minutes begins teobromine stage, which is very often the cause of frequent road
accidents.
THE AGENTS APPLIED AT THE OBESITY
Kapustyanskaya A., Mokrushina Yu. –the 4-th year students
Scientific leaders - Assoc.Prof. Anokhina R.A., Kostina V.V.
Obesity is in excess adjournment of fats. It results from disturbance of power
balance for a long time. At the same entering of energy with a nutrition surpasses its
expense, for example at an insufficient exercise stress. It must be kept in mind also genetic
31
predisposition to excess body weight. Besides, an important role is played by mental and
neuroendocrinal factors, and also age.
Obesity represents a serious medical problem it is risk factor of development of
diabetes, cardiovascular diseases, an osteoarthritis and many other chronic diseases.
Besides, the premature mortality of such contingent of people is enlarge.
Phenaminum – bond from group of phenylalkilamin with the central and
peripheric sympathomimetic properties belongs to effective anorexigenic substances.
The mechanism of its action is mainly that it strengthens release from the nervous
terminations of norepinephrine and Dofaminum their return capture.
For depression of caloric content of a nutrition it is recommended to limit
reception of sugar for a long time or to use its substitutes of non carbohydrate structure
(like Saccharinum, aspartame) which to taste are similar to saccharin, but have low caloric
content or are badly soaked up from a digestive tract. It is very rational way as
carbohydrates (glucose) are one of important sources of synthesis of fats in an organism.
Appetite suppresses and melanocortin, interacting with special receptors (MC4).
NEUROBRUCELLOSIS
Kapustyanskaya A., Mokrushina Yu. – the 4-th year students
Scientific leaders – Cand.Med.Sc., Assoc. Prof. Karnauh A.I..Kostina V.V
It causes by several species of Gram-negative bacteria of Rubella. The main source
of an infection are the sick animals (large and small cattle) representing the natural tank of
brucellas in the nature. Infection occurs by contact, nutritional, airborneways.
Clinical implications. The incubation period is averages 2-4 weeks in the average,
but can be much longer. The onset of the illness is acute, from temperature increase up to
40 °C, a cold fit, profuse sweat, joint and muscular pains, sleeplessness, a headache, a
hyperadenosis, hepatosplenomegaly.
The brucellous encephalitis is shown by paralyzes of extremities, conduction
disturbances of sensitivity, hyperkinesis, coordination disorders. The CNS lesion at a
brucellosis has a polymorphic clinical picture. The combined CNS lesions with
development
of
a
meningocephalitis,
encephalomyelitis,
meningoencephalomyeloradiculitis are quite often observed
In an acute stage and at meningitis and an encephalitis parenteral administration of
antibiotics is recommended. At chronic forms of a brucellosis the antibrucella polyvalent
vaccine is administered.
VASCULAR DEMENTIA
Mokrushina Yu., Kapustaynskay A.A. – the 4-th year students
Scientific leaders – Prof. Karnaukh A.I., Kostina V.V.
Vascular dementia - the expressed disturbance of cognitive functions owing to
cerebrovascular disorders leading to disturbances of social functions, professional skills
and ability to self-service.
For the dementia it is characteristic acute emergence of cognitive disturbances for
the first month (but no more than three months) after the first or repeated strokes. The
multiinfarctive vascular dementia is mainly cortical, it develops gradually (for 3-6 months)
after a series of small ischemic episodes. At a multiinfarctive dementia there is
"accumulation" of infarcts in a brain parenchyma. Existence of arterial hypertension and
32
signs of a lesion of deep departments of white substance of cerebral hemispheres is
characteristic of a subcortical form of a vascular dementia.
Retardation, rigidity of all mental processes and their lability, narrowing of a focus
of interest are characteristic of patients with a vascular dementia. At patients it is noted
perceptible depression of cognitive functions (memory, attention, thinking, orientation,
etc.) and difficulties when performing functions in everyday life and family life (service of
oneself, cooking, shopping, filling of financial documents, orientation in a new situation,
etc.), loss of social skills, adequate assessment of the disease. Depression of memory on
last and current events - the characteristic symptom of a vascular dementia, however
mnestic disorders are expressed more softly in comparison with a dementia at Alzheimer's
disease. Disturbances of memory are shown mainly when training: storing of words are
complicated, visual information, acquisition of new movement skills. Generally active
procreation of material suffers while simpler recognition is rather safely. At later stages
disturbances of abstract thinking and judgments can develop. The expressed narrowing of
volumes of any attention, appreciable disturbances of its functions - concentration,
distributions, switchings are defined.
INHIBITORS OF A PROTON POMP AS REMEDY FOR A PEPTIC ULCER OF
A STOMACH
Mokrushina Yu., Kapustaynskaya A. – the 4-th year students
Scientific leaders – Assoc.Prof. Anokhina R.A., Kostina V.V.
Inhibitors of a proton pomp (H+/K blockers +-Atfazy, further IPP) — antisecretory medicinal preparations for treatment the acid dependent diseases of a stomach,
duodenum and esophagus due to blocking of a proton pomp (N + / To +-Atfazy) parietal
cells of a mucosa of a stomach and decrease, thus, secretions of the hydrochloric acid.
Inhibitors of a proton pomp are the most effective and modern medicines at
treatment of ulcerous damage of a stomach, duodenum and esophagus providing decrease
of acidity and, as a result, aggression of a gastric juice.
The mechanism of action of an inhibitor of a proton pomp. Inhibitors of a proton
pomp, after passing of a stomach, get to a small bowel where they are dissolved, then on
a blood flow come to a liver in the beginning, and then get through a membrane into
parietal cells of a mucosa of a stomach where concentrate in a secretory canaliculus. Here,
at acidic value рН, inhibitors of the proton pump are activated and turn into a tetracyclic
sulfenamid which is loaded and therefore it isn't capable to get through membranes and
doesn't leave an acidic compartment in a secretory canaliculus of a parietal cell. In this
form inhibitors of a proton pomp form strong covalent bonds with mercaptogroups of the
cysteic remains of H+/K +-Atfazy that blocks conformation transitions of a proton pomp,
and it becomes irreversible the secretion of the hydrochloric acid excluded from process.
So production of acid to renew, synthesis of new H+/K +-ATFAZ is necessary. A half of
H+/K +-ATFAZ the person is updated in 30-48 hours and this process determines
duration of therapeutic action of IPP. At the first or single dose of IPP its effect isn`t
maximum as not all proton of a pomp are built in a secretory membrane by this time, a
part of them is in cytoashes. When these molecules, and also again synthesized by H+/K
+-ATFAZ appear on a membrane, they enter interaction with the subsequent doses of
IPP, and its anti-secretory effect is implemented completely.
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DISTOTION OF A COAT HANGER
Mokrushina Yu.,Kapustyanskaya A.– the 4-th year students
Scientific leaders – Cand.Med.Sc. Mirlas E.M., Kostina V.V.
Distotion of a coat hanger (shoulder dystocia), further DP — a complication of the second
period of childbirth when after the birth of a head there is a delay of a forward shoulder
for symphysis or peg and socket articulation in a pelvis, and back arm at this time or
densely concisely in a sacral hollow, or is under the cape therefore further promotion of a
fetus on patrimonial ways of mother stops.
Maintaining tactics:
It is necessary to work quickly, avoiding three things (3 P: pulling, pushing, pivoting):
· not to pull (not to make excessive tractions for a head);
· not to push (not to try to squeeze out a fetus);
· not to bend (not to make excessive lateral bendings of a head).
In English-speaking obstetrics there is a mnemonic abbreviation of HELPERR [H — help
to call to the aid, E — evaluate for episiotomy (to think of an epiziotomiya), L — legs,
legs (Mac-Roberts's acceptance), P — pressure, pressure (over a pubis), E — enter, to
enter a hand (for internal turn), R — remove, to remove, take the back handle, R — roll,
to turn ("on all four").
Mac-Roberts's acceptance - a method is effective, easy, safe and quickly in fulfillment.
Thighs bring into contact with a stomach, trying to obtain at the same time reduction of a
lordosis and an inclination of a pelvis. This acceptance, naturally, doesn't reduce the sizes
of a small pelvis, but in case of movement of a lonny joint there are cranially conditions
for release of a forward arm.
Thus, timely and correct rendering of obstetric benefit in case of a distotion of a coat
hanger promotes decrease in frequency of patrimonial injuries of newborns.
LONELINESS PSYCHOLOGY
Mokrushina Yu., Kapustyanskay A. – the 4-th year students
Scientific leaders – Brush E.G., Kostina V.V.
One of representatives of psychoanalysis of Zilburg considers distinguished
loneliness and privacy. Privacy it read an essence "normal" and the "passing mood"
resulting from absence specific "someone".
The loneliness is insuperable, unpleasant (it as "worm" corrodes heart), constant
feeling. Zilburg considers that such lines of the personality as a narcissism, megalomania
and hostility, and also aspiration to save infantile feeling of own omnipotence are the
reasons of loneliness. Such nartsissistic orientation begins to form at children's age when
the child together with feeling of joy to be darling feels the shock caused by the fact that
he is small, feeble being, forced to wait for satisfaction of his needs from others.
Fromm-Reihman, assigning the loneliness reasons, emphasizes a harmful
consequence of a premature excommunication from maternal kindness.
Weiss selected two types of loneliness: emotional and social. The first is result of
absence of such tight intimate attachment as loving or matrimonial. The social loneliness
is result of absence of significant friendly relations or feeling of a community that can
express in experience of melancholy and feeling of a social marginality.
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STRUCTURE OF NAILS IN NORM AND UNDER ONYCHOMYKOSIS
Zaitseva O. – the 2nd year student
Scientific leaders – Prof., Dr. Med. Sc. Krasavina N. P., Kostina V. V.
Nails - horny epithelial skin appendages in the form of plates lying on the dorsal
surface of the distal phalanges.In the nail apparatus there is proper nail plate, bed, matrix,
cuticle and nail ridges.Nail functions: prevents damage of the fingertips, increase the
sensitivity of the fingertips, plays an important role when manipulating with small objects.
The growth of the nail - the constant formation of a new substance of the nail plate.
Various factors influence on the rate of growth.
About the state of health we can judge by the appearance of nails mind: their
shape, pattern and color changes during the flow of the pathological processes in the body.
Pink, shiny, smooth and fully appropriate form of finger nails - a sign of absolute health.
One of the manifestations of pathological changes in the structure of the nail is a
nail fungus (onychomycosis). Onychomycosis - the most common disease in which the
nails turn yellow, become brittle and thick, covered with cracks. The disease is caused by
three types of fungi, but most fungi species Trichophyton rubrum.
Prevention is based on personal and social activities and health education. It is
important to observe good personal hygiene, use of individual shoes.
NERVE DAMAGE IN HERPETIC INFECTION
Pchelina K., Shpidonova R. - 4th year students
Scientific leaders: Cand.Med.Sc., Assoc. Prof. Karnauh A.I..Kostina V.V.
The herpes virus is a DNA-containing and belongs to the family of herpes
viruses. A characteristic feature of all herpesviruses is their ability to remain in a latent
form in the ganglia and lymphoid tissue.
Herpes simplex virus 1,2 (HSV - 1,2, HSV-1,2), infection usually occurs by
contact. After recovery, the virus migrates to the trigeminal ganglia, where HSV-1 and
HSV-2 in more sacral ganglia. For reactivation of the virus results in decreased immunity
and its output to the periphery, which is manifested stomatitis or characteristic rash in the
mouth and on the lips, if it is HSV-1 and HSV-2 is characterized by the manifestation of
the lesions on the genitals. Gerpetic complication is encephalitis. There is a clinic of
acute focal encephalitis with severe symptoms. There are foci of necrosis in the frontal
and temporal lobes, which can lead to transtentoraln wedging, which will lead to death.
You can recover from neurological deficits.
Herpes simplex virus type 3 (TSB-OG) Varicella-zoster (VZV) causes two types of
lesions - chicken pox and shingles. If the virus damages the spinal ganglia, then there is a
picture of herpes zoster or zoster (Human herpesvirus 3, HHV-3). Shingles is caused by
reactivation of the virus in the lymph nodes, in those early recover from chickenpox.
There are blisters on the skin dermatome area. There are severe radicular pain in the area
of herpetic vesicles (persistent or recurrent, burning and painful, poorly amenable to
analgesics). Prognosis is favorable. Neuralgic pains can be stored for a long time. In rare
cases there may be relapsing course. varicella encephalitis can occur when lowered
immunity. It occurs with a frequency of 0.1 - 0.5%. At 2-3 day appear rash, encephalitis
development is associated with the penetration of the virus into the subarachnoid space
after the stage of viremia. There is a demyelinating process with perivenous
inflammatory infiltration, damage often occurs in the cerebellum, brain stem, at least - in
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the spinal cord and the cerebral hemispheres. Out of encephalitis is characterized by
complete recovery.
PLOT OF DELIRIUM
Shpidonova R. - the 4th year student
Scientific leaders- Brush N. G., Kostina V. V.
This is the main content of the delusional concept, which can take many forms.
Delusional judgments of the patients are subjective, and almost unique, but they reflect the
dominant ideas in society. Classification based on the ideas of V. Grezingera includes
persecutory delusions, depression and grandeur.
Delusions of grandeur is manifested in patients with allegations that they have
extraordinary intelligence and strength. By the greatness of delirium delusions of wealth
are similar, inventiveness, reformists, of high birth, love. When delusions of wealth patient
claims he owns countless treasures.
As a rule, persecutory delusions (delusions of persecution) always takes place with
a sense of fear, mistrust and suspicion towards others. Often, "pursued" becomes the
persecutor. By persecutory delusions are delusions relationships, values, harassment,
exposure, poisoning, injury, staging. jealousy.
For depressive delirium is characterized by negative emotions, pessimistic
installation. The most typical for this group of self-incrimination delusion, selfdeprecation and sinfulness, are usually observed in depressive states - when the depressive
phase of a circular psychosis, involutional melancholia. For depressive hypochondriac
delirium refers to dysmorfomanic. It is characterized by unreasonable concern patients
who are at imaginary signs of serious and incurable disease, exaggerated attention to the
health of the patient. Most often hypochondriacal complaints related to physical health,
and so hypochondriac syndrome is sometimes interpreted as delusions of bodily
transformations, delusions imaginary physical illness. However, there are cases when
patients say they are sick by severe mental illness at. Patients it is dominated a sense of
sadness and depression that, is often the cause of suicidal behavior, sometimes patients are
punished physically abused.
MONITORING OF COMMUNITY-ACGUIRED PNEUMONIA
Nikitina D., Skripelev A. - the 3-rd year students
Scientific leaders – Prof. Chubenko G. I., Kostina V. V.
Identification of patients with community-acquired pneumonia (CAP) carried out by
experts of therapeutic and prophylactic institutions (TPI) in all types of medical care.
CAP diagnosis is considered definite if there’s a radiologically confirmed focal
infiltration in patient of the lung tissue and by the presence of clinical symptoms: acute
fever at the beginning in the disease, cough. The final diagnosis of the disease, flowing
with symptomcomplex is diagnosed in considering of clinical and laboratory
examination case history of the patient.
The decision to hospitalize patients with a confirmed diagnosis of CAP takes the
physician in with the standards of medical care.
In every instance in CAP doctors of all medical institutions in the prescribed manner
within 12 hours send urgent notification to the Federal Service on the place of detection
of the disease, specifying the diagnosis and the results of the study.
36
Laboratory examination of CAP patients with sporadic disease is carried out in
laboratories accredited in accordance with established procedure in the direction of
health care facilities.
In severe CAP it is expedient to conduct research: on legionellosis pneumonia in
generalized dangerous infections. These studies are conducted in organizations of
microbiological work in the prescribed manner.
When registering an epidemic outbreak of CAP with the group incidence laboratory
tests are conducted in the laboratory of medical organizations and organizations that
provide state sanitary and epidemiological supervision.
ANALYSIS OF THE FREQUENCY OF STROKE IN PATIENTS
WITH HYPERTENSIVE DISEASE
Pushkov A., Skripelev A., Nikitina D., Baldanov E. - the 3-rd year students
Scientific leaders- Cand. Med. Sc. Kvasnikova Yu. V., Kostina V. V.
Hypertension (H) - the most common disease that is associated with a
significant risk for cardiovascular development and death. In Russia, the prevalence of
H in women - 40.4%, among men - 37.2%. Hyhertension in its development is
associated with structural and morphological changes in the vascular system of the
head.
In CBHD AR "Blagoveshchensk City Clinical Hospital" there was
retrospective analysis which aim was to identify the incidence of acute cerebrovascular
accident (CVA) in patients with hypertension. It was investigated 95 case histories in
2015 at the age of 47 up to 89 years old. In 85.2% of patients there was diagnosed
ischemic stroke (IS), in 14.8% of patients - bleeding (HS) one.
Among patients with IS lesion usually localized in vertebro-basilar pool, in the
pool of left and right middle cerebral artery. Patients lesions were more frequent in the
right hemisphere of the brain and cerebellum pool.
In most people there were noted following harbingers of stroke: headache
(92.6%), dizziness (66.6%), speech disorder (44.7%), nausea (35.6%), the rise in blood
pressure (32.5% ), epistaxis (1.7%).
Analysis of hospital outcomes showed that there were discharged 7.6% with
recovery, with an improvement - 78.8%, "no change" - 0.6%. The lethal outcome is set
at 11.5% of patients.
The results can be used in the planning of activities for the prevention of
cerebral complications of hypertension.
CONSERVATIVE TREATMENT OF CHRONIC TONSILLITIS
Piura D. – the 4th year student
Scientific leaders – Dr.Biol.Sc.Simonova N.V., Kostina V.V.
Chronic tonsillitis is the inflammation of the tonsils that occurs with periodic
exacerbations in the form of angina.
Medications are selected from the following groups:
1)Antibiotics. Drugs of antibiotic therapy is assigned only in the period of
exacerbation, and only after a crop on sensitivity of causative agents (Amoxicillin,
Cephalexin, Oxacillin, etc.).
37
2)Probiotics. Their appointment is necessary during treatment of chronic
tonsillitis by antimicrobials (Normoflorin, Calm, Primadophilus, Acipol, Narine).
3)Antiseptics. They can be in the form of tablets or lozenges: Strepsils, Sage,
Septolete, Faringosept, Sebidin, Streptocid. Also they are available in sprays and aerosols:
Miromistine, Bioparox, Ingalipt, Hexetidine. preparations for the lubrication of the tonsils
are very effective: Lugol, Hlorofillipt, Yoks, Yodinol.
4)Analgetics. In severe pain they are often prescribed drugs of the group of nonsteroidal anti-inflammatory agents (NSAIDs): Ibuprofen(Nurofen).
5)Antihistamines are needed in the treatment regimen as decongestant and
desensitizing medicines. This group of drugs enhances the action of other drugs and reduce
the time of treatment . Antihistamines of the latest generation are usually prescribed
(Cetirizine/Zyrtec,Zodak,Cethrin; Fexofenadine/Telfast).
6)Immunomodulatory drugs. In the treatment of tonsillitis it is recommended to
use natural remedies: chamomile flowers, propolis, tincture of ginseng. Medication is
Imudon, rutaskorbin Rue "Belmedpreparaty", Lizobakt.
7)Mitigating drugs. To eliminate dryness and sore throat recommended to use a
natural plant oils (sea buckthorn, apricot, peach).
INFLUENCE OF AN ELECTROMAGNETIC ON HEALTH OF THE PERSON
Mokrushina Yu., Kapustyanskay A. – the 4-th year students
Scientific leaders – Cand.Med.Sc. Goryacheva S.A., Dr.Med.Sc. Prikhodko O.B.,
Kostina V.V.
The body of the person has its own electromagnetic field as any organism on
the Earth thanks to which all cells of an organism work harmoniously. Electromagnetic
radiations of the person are still called a biofield (his visible part — aura). Don't forget
that this field is the main protective membrane of our organism from any negative
impact. Destroying it, bodies and systems of our organism become an easy spoils for
any pathogenic factors.
If other sources of radiation, much more powerful, than the radiation of our
body, begin to affect our electromagnetic field, so chaos in an organism begins. It also
leads to cardinal deterioration in health.
And not only household appliances, mobile phones and transport can be such
sources. The big congestion of people has also considerable impact on us,also mood of
the person and his attitude towards us, geopathogenic zones on the planet, magnetic
storms, etc.
Feeble electromagnetic fields (EFF) by power of the 100-th and even
thousand shares of Watts of high frequency are dangerous to the person that intensity
of such fields matches with intensity of radiations of a human body at usual functioning
of all systems and organs in his body. As a result of this interaction own field of the
person is distorted, provoking development of various diseases, mainly in the most
weakened organism links.
The most negative property of electromagnetic signals is that they have
property to collect in an organism over time. At people, by the nature of activity there
is a lot of using various office equipment – computers, phones – decrease of immunity,
frequent stresses, dropping of sex activity, increased fatigue are revealed.
The circulatory system, brain, eyes, immune and sexual systems are mostly
subjected to influence of electromagnetic fields.
38
ANTINEOPLASTIC ORIGIN REMEDY OF VEGETABLE
Neverova A., Soloveva I. - the 4th-year students
Scientific leaders – Assoc.Prof. Anokhina R.A., Kostina V.V.
According to the classification D.A.Kharkevich, anticancer agents of plant origin
can be represented by the following groups: Vinca alkaloids - vinblastine, vincristine,
Alkaloids yew tree (taxanes) - paclitaxel, docetaxel, Podophyllotoxin secreted from the
thyroid podofilla - etoposide, teniposide, Alkaloids Colchicum speciosum - demecolcine
(kolhamin), colchicine. Vinca alkaloids - structurally related compounds in the chemical
structure of which there are two polycyclic units - catarantin and vindoline. Antitumor
effect is due to the influence of these alkaloids on cells in M- phase of the cell cycle. Natural
vinca alkaloids are used for the treatment of rapidly proliferating tumors. Taxanes chemotherapeutic agents are widely used in clinical practice in the 1990s. Paclitaxel - first
taxane derivative with anticancer activity was isolated in 1967 out of bark of Pacific yew
(Taxus brevifolia). Docetaxel is produced by chemical synthesis from natural raw materials
- European yew needles (Taxus baccata). Taxanes are a class of drugs acting on
microtubules.
Podophyllotoxin. Anticancer agents of plant origin is podophyllin (Berberidaceae).
Podophyllin contains at least 40% of podophyllotoxin, alpha- and beta-peltatiny.
Podophyllotoxin is used topically in the treatment of warts and other skin lesions.
Camptothecins - semisynthetic camptothecin derivative alkaloid isolated from the shrub
stalks Camptotheca acuminata are presented by topotecan and irinotecan. In accordance
with the mechanism of action they are a group of topoisomerase inhibitors. Currently,
irinotecan is the drug of first-line treatment for colon cancer. Topotecan is widely used in
the treatment of lung and ovarians cancer.
Thus, anticancer therapy is not limited by surgery, chemotherapy and radiotherapy.
One of the possible options for enhancing the effectiveness of the treatment is a continuous
method, offering alternating support and specific methods, in particular the use of herbal
medicines in oncology, role and place of which in the prevention and treatment of cancer
in these days are not great. A wide range of curative action of anticancer herbs should be
used in the treatment of tumor.
ETIOLOGY OF DISSEMINATED SCLEROSIS
Neverova A., Soloveva I. - the 4th-year students
Scientific leaders – Dr.Med.Sc. Karnaukh V.N., Kostina V.V.
Disseminated sclerosis (DS) - a chronic demyelinating disease of the nervous
system with a pronounced variability in clinical presentation, relentlessly progressive
course and unknown etiology. The etiology of DShas not been established until the end, it
is believed that this disease is multifactorial one. DS currently associated with the
following factors: environmental factors, genetical, infectious, hormonal. The
environmental factors are: geographical location and deficiency of vitamin D. The climate
also makes a difference in the development of DS. Higher incidence corresponds to higher
latitudes in the northern hemisphere. Epstein-Barr virus and low levels of vitamin D are
the most studied environmental factors that play a role in the etiology of DS. It is assumed
that vitamin D alters the immune response to the virus and these factors exert a synergistic
effect, increasing the risk of developing DS.The fact that women more often than men
39
suffer from DS, gives reason to think about the role of hormonal factors in the development
ofdisease. In women with DS in the 3rd trimester of pregnancy, when the frequency of
exacerbations of multiple sclerosis significantly is reduced, there was found significantly
higher levels of vitamin D. In men there was identified estradiol relationship between the
concentration and the degree of brain tissue damage.According to data obtained during the
population, genietological and twin studies the genetic predisposition to multiple sclerosis
were elucidated. Thus, a plurality of these factors leads to the most downstream progressive
DS. Further study of the etiology of this disease allows to understand better the mechanism
of its development, which will make it possible by acting on the pathogenesis of the links
a more effective treatment.
RESEARCH METHODS IN NEUROLOGIC PRACTICE – A LUMBAR AND
SUBOCCIPITAL PUNCTURE
Margasova A., Terentieva E. – the 4-th year students
Scientific leaders – Cand.Med.Sc., Assoc. Prof. Karnauh A.I.., Kostina V.V.
Lumbar puncture. Indications:
1. The medical purpose is introduction of antibiotics at infectious lesions of nervous
system, cytostatics (at an oncology), sanitational removal of a bloody liquor at
subarachnoid hemorrhages.
2. Diagnostic purpose: definition of a cytosis, inflammatory diseases of a central
nervous system, craniocerebral injury (at differentiation of concussions from bruises),
vascular diseases.
Contraindications:
1. Signs of rising of intracranial pressure - a congestive optic disk of visual nerve.
2. Signs of dislocation syndromes, blockade of liquoroproducing channels,
displacement of median structures.
3. Infectious lesions of a skin or soft tissues in lumbar area.
Technology of performance: Introduction of a needle for an intake of cerebrospinal
fluid is dangerously if higher than the L2 level, because it can lead to injury of a spinal
cord. For definition of the place of injection there is the line connecting the upper edges
(crests) of ileal bones. The aspirating needle is introduced between spinal processes of L34 or L4-5.
Suboccipital puncture. Indications:
It is made in case of researches’s need of cerebrospinal liquid when the lumbar
puncture can't be executed, at the descending myelography for the purpose of definition of
permeability of a subarachnoid space of a spinal cord.
Contraindications:
1. Craniospinal tumors.
2. Volume processes in a back cranial fossa.
3. Anomalies of development of occipital and cervical area.
4. Local purulent processes.
5. The expressed rigidity of occipital muscles.
Technology of performance: puncture of a skin, a hypodermic fat, a membrane
between the rear edge of a big occipital opening and a back handle of an atlas. The puncture
is made only by the neurosurgeon under control of a roentgenoscopy (depth of the surface
from 4-5 cm).
40
ALKALOSIS AS A VIOLATION OF THE ACID-BASE STATE OF THE
ORGANISM
Andreychenko M., Selina I. - the 2nd year students
Scientific leaders - Cand. Med. Sc. Egorshina E.V., Kostina V. V.
Alkalosis - a violation of the acid-base balance in the body, manifested by excessive
accumulation of alkaline compounds. For alkalosis it is characterized by the loss of acids
and excessive accumulation of alkaline compounds, resulting in respiratory failure and
metabolic disorders. Types of alkoloza: 1) Respiratory alkalosis is caused by the loss of
CO2 (carbon dioxide) from the exhaled air due to hyperventilation. For example, children
with strong crying, high in the mountains, breathing exercises performed incorrectly,
excessive artificial respiration, certain nerve diseases); 2) metabolic alkalosis develops
when the body losses acids (for example, when strong vomiting in pregnant women), and
administered when is a large number of bases, such as alkaline mineral water, soda. It is
characterized by a primary increase in blood HCO3- with a compensatory increase in
pCO2. Alkalosis causes a decrease of ionized calcium in the blood, which leads to spasms
and muscle tension. At higher pH of Serum more then 7.55, mortality reaches 40%. In
alkalosis absorption of minerals is disturbed. Food is digested much slower, allowing
toxins from the digestive canal to enter into the bloodstream. High alkali content in the
body is dangerous and difficult adjusting. Pathogenesis during alkalosis: When alkalosis
(especially associated with hypocapnia) there occur general and regional hemodynamic
disturbances: decreasing of cerebral and coronary blood flow, reducing of blood pressure
and cardiac output. Neuromuscular excitability increases, muscle hypertonus occurs until
the development of seizures and tetany. Often there is inhibition of intestinal motility and
constipation development; reduced respiratory center activity. For gas alkaloza it is
characteristic by reduce of mental capacity, dizziness, fainting may occur.
CHARACTERISTIC FEATURES OF RETINA IN DIABETES
Rukosuev E. - the 2-nd year student
Scientific leaders: Kozlova V.S., Kostina V.V.
The vision provides people with information about the three-dimensional
structure and the spectral composition of the surrounding world. These tasks are performed
by recording visual sensors - photoreceptors of electromagnetic waves reflected from the
surrounding objects. In the retina of each person's eyes there are the photoreceptor cells
(rods and cones). Color is better perceived by the action of light on the central retinal hole.
The photoreceptor neurons - consist of outer segment containing visual pigment, the
internal segment, connecting the legs, with a large part of the nuclear core and the
presynaptic terminal. The outer segment of the photoreceptor contains a lot of drive. The
rods contain rhodopsin pigment responsible for the black-and-white vision. For the
perception of color vision idopsin is responsible. In the absorption of a quantum of light in
a molecule of rhodopsin cis-retinal goes into a trance. Following this the protein portion of
the molecule comes into a state metarhodopsin II. After a number of transitions in the outer
segment occurs closing of ion channels. Due to the concentration of gradient there occurs
hyperpolarization of the cell membrane. Photoreceptors synaptically linked to bipolar
neurons. From them nerve signal is transmitted to the ganglion cells. The interaction of
neighboring retinal neurons provides horizontal and amacrine cells. Visual information
from the retina by the optic nerve fibers rushes to the brain. The blood supply to the inner
41
layers of the retina is carried out of the central artery of the retina, which is part of the
eyeball in the center of the optic nerve and then is divided to provide the power the entire
inner surface of the retina. The outer layers of the retina depend mainly on the diffusion of
nutrients from the choroidal vessels. During prolonged hyperglycemia there appears
microaneurysm, which is accompanied by the occlusion of the congestion in the thickness
of the retinal blood cells, microparticles, proteins and fats. However, some areas are
experiencing ischemia. These processes stimulate neovascularization, accompanied by
hemorrhage into the vitreous and the growth of fibrous tissue. This ultimately leads to
retinal detachment. Due to the accumulation of blood clots there may be increase of
intraocular pressure. This in it is turn leads to damage of the optic nerve. Patient
compladints of appearance of blurred vision, poor night vision and distortion on objects.
This disease is referred to as diabetic retinopathy.
HEBEPHRENIC SCHIZOPHRENIA
Trimanova S., Rogozina V., Rustamova L. - the 4th year students
Scientific leaders – Bugrova M.I., Kostina V.V.
Schizophrenia - the chronic mental desease, inclined to progressing, which is shown
by violation of coherence between various mental functions, ambivalence, a perversion of
processes of thinking and the accruing changes of the person in the form of a closure,
passivity and emotional coldness. Hebephrenic schizophrenia- one of schizophrenia
subtypes which is characterized by existence in behavior of the expressed lines of
childishness silliness. For the first time the hebephrenia was described by Gekker (1878)
as a self-contained mental disease , it was carried by Krepelin to schizophrenia
subsequently. The name «hebephrenia» indicates that this mental disorder peculiar to the
young age hebephrenia begins at 15-19 years old. The hebephrenic type of defect-type of
defect is shown by a picture of a steady hebephrenic syndrome which keeps not less that
within half a year, without conceding and without being softened considerably under the
influence of the most intensive treatment with antipsychotic neuroleptics. The structure of
a heberphrenocatonic syndrome reveals: 1)Motive and strong-willed changes in a type of
grimacing, silliness, regress of instincts, unmotivated euphoria. 2) Emotional
inadequacy.3) Disorders of thinking-reasoning and disruptiveness. 4)Brad and
hallucinations which do not act into the forefront and have character of inclusions. The
diagnosis of a heberphrenic form is made with the common criteria of schizophrenia : the
persistent, daily hallucinations not less than a month accompanied with the crazy ideas
without distinct affective coloring or it is long the remaining supervaluable ideas, the
neologisms, episodes of an uncontrollable stream of thoughts resulting in disruptiveness of
the speech, the increasing apathy, impoverishment of the speech. Neuroleptics are used at
treatment of hebephrenic schizophrenia: Chlorpromazinum, Haloperidolum,
Thioproperazinum, Trifluperidolum, Trisedylum, tranquilizers, and also insulin therapy
and hyper vitamin therapy should be. Hebephrenic schizophrenia schizophrenia should be
differentiated with tumirs of frontal lobes and dementias at a disease of Peak and
Gentington.
ANABOLIC STEROIDS
Rogozina V., Trimanova S., Rustamova L. – the 4th year students
Scientific leaders - Assoc. Prof. Anokhina R.A., Kostina V.V.
42
From a chemical point of view of anabolic steroids - are cyclopeutanperhydrophenatren
derivatives, which is the structural basis of male sex hormones. Therefore anabolic
steroids are artificially synthesized derivatives of the male sex hormone - testosterone.
They enhance the processes of nucleic acid synthesis, protein in the cells, various
enzymes and thereby affect almost all types of metabolism. This ultimately leads to an
increase in body weight due to enhanced muscle growth, decrease in percentage of fatty
tissue and increase in physical performance: speed-strength and endurance. The
mechanism of action of anabolic steroids is that they are soluble in fats, so they can
penetrate through the membrane into the cell, where the androgen receptor binds to the
nucleus and cytoplasm. The effectiveness of anabolic steroids dependes on the following
factors: the specificity of the steroid, the individual characteristics of the organism, the
scheme of steroid use, the availability of sufficient quantities of amino acids and energy
for the synthesis of new proteins in the cell, the level of physical activity when taking
medications as lack of volume will negatively affect efficiency of the drug. As a result of
research it has been found that up to 80% of the athletes taking anabolic steroids, suffer
from impaired of liver function, and were marked even deaths. A number of studies
indicate the possibility of adverse consequences of even 15-20 years after the end of
supplementation. Anabolic steroids are banned for use by the medical commission of the
International Olympic Committee.
ATYPICAL FORMS OF ALCOHOLIC PSYCHOSIS
Mikhailova V., Kazakov A. – the 4-th year students
Scientific leaders - Brush N.G., Kostina V.V.
Atypical forms are a fantastic delirium and delirium; acute hallucinosis,
accompanied by short-term numbness or stupor with severe depression; hallucinosis with
true psychic automatism; visual hallucination. The appearance of atypical psychoses after
typical speaks about the rise encephalopathic changes. Further deepening encephalopathy
can lead to the disappearance of atypical symptoms and occurrence of organic psychoses.
Atypical delirium - symptoms include certain manifestations of the syndrome
Kandinsky - Clerambault. Atypical delirium is accompanied by a sufficiently deep
dimming of consciousness, severe motor and speech excitement. It is difficult to come into
contact with patients, their speech is abrupt and inconsistent at psychosis. The current
atypical delirium can be long, especially when the specific weight of acoustical
hallucinations is big.
Fantastic delirium (oneiric alcohol) occurs at an altitude of atypical or systematic
delirium, as well as at the height of acute hallucinosis. There are complete disorientation,
visual hallucinations scenic fantastic content, sharp fantastic delirium, combined with the
various manifestations of the syndrome Kandinsky-Clerambault, disorders of body schema
at the depersonalizatory disorders.
Atypical hallucinosis is accompanied by stupor, the appearance of short-term or severe
depression. The stupor with catalepsy lasts only several hours, the further course of
psychosis is usual. In severe depressive symptoms there marks the motor and ideational
confusion, depressive delusions, accusing and condemning the content of hallucinations,
melancholy with a sense of hopelessness.
43
UROLITHIASIS DISEASE
Mikhailova V., Kazakov A. – the 4- th year students
Scientific leaders - Cand. Med. Sc. Velichko D.N., Kostina V.V.
Urolithiasis - a biophysical phenomenon whereby in urine especially in high
density crystals are formed, their growth and aggregation that leads to disruption of the
structure and function of the urinary system.
Types of urinary stones: 1) Oxalate - formed from oxalic acid (use of plant foods). Dense,
black and gray, prickly. 2) Urate - formed from uric acid (due to eating meat). Yellowbrown or dark - orange, smooth and rough. 3) Phosphate - formed from phosphoric acid.
Smooth, soft, rounded. 4) Сysteic - arises as a result of congenital metabolic abnormalities,
when the level of cystine in the urine is constantly upgraded. 5) Mixed
The principles of treatment:
1) Conservative (Diet therapy, anti-inflammatory therapy, monitoring of pain, litholytic
therapy, drug therapy: Cystone, Cystenalum, Olimetin, Urolizin, Urolesan, Avisan,
Phytolysinum, Litovt "U" and others, herbal medicine, physiotherapy, sanatorium
treatment).
2)Surgical treatment (pyelolithotomy, nefroliotomiya, ureterolithotomy,
cystolithotomiya).
INTESTINAL DYSBACTERIOSIS
Mikhailova V., Kazakov A. – the 4-th year students
Scientific leaders - Cand. Med. Sc. Kruglyakova L.V., Kostina V.V.
The intestinal dysbiosis is the clinical laboratory syndrome arising at a number of
diseases and clinical situations which is characterized by change of qualitative and or
quantitative structure normal microflora, metabolic and immunologic disturbances, and
also at a part of patients followed by clinical symptoms of a lesion of an intestine.
Change of composition of intestinal microflora happens at the following
situations:
1. At almost healthy persons where a role is played: age factor, seasonality,
alimentary factor, professional factor.
2. At patients with a disease of a gastrointestinal tract, in the presence of parasites, at an
oncopathology.
3. At use of antibiotics, non-steroidal anti-inflammatory drugs, cytostatic, hormones,
antituberculous drugs.
4. In the presence of a radiative factor. There is a prevalence of defective strains of E.coli.,
what promotes weakening of E.coli properties., the number of the strains producing a
cholesterin is enlarged, capsular forms prevail (clostridiums, klebsiyela) at age
dysbacteriosis.
Treatment of dysbacteriosis:
1. A diet: porridge (rice, semolina, buckwheat) with a small amount of butter, boiled meat,
fish, a bird, steam cutlets, meatballs, a souffle.
2. Medical physical culture (at locks).
3. Eubiotiki (Intetrix, Intestopan, Ertsefuril).
4. Antibiotics (depending on structure of an opportunistic or pathogenic microflora).
5. The drugs are removing swelling (Ditsetet, Espumisan, Meteospazmil).
6. Enzymes (Mezim-forte, Kreon, Panzytrat, Pancreatinum).
44
7. At locks — Duphalac, Duspatalin.
8. At a diarrhea — Smekta, Almagelum, Imodium (Loperamide), Ditsetet, Sandostatin,
Meteospazmil.
9. Sedative therapy (Prosulpin, Novopassit, Amitriptyline, Valeriana).
10. Probiotics — Lactobacterin, Bifidobakterin-forte, Bificol, Bifiform, Probifor.
11. Prebiotics — Hilakforte, Lactofiltrum.
12. Sanatorium treatment.
PERINATAL OUTCOMES OF GESTATIONAL DIABETES
Mikhailova V., Kazakov A. – the 4-th year students
Scientific leaders - Can. Med. Sc. Zaritskay E.N., Kostina V.V.
According to classification of World Health Organization, "gestational Diabetes" is the
diabetes revealed during pregnancy and also disturbance of tolerance to the glucose which
is also revealed during this period. The reduced sensitivity of cells to own insulin which is
bound to high content in a blood of hormones of pregnancy is its reason. Level of sugar in
blood most often comes back to norm after the birth. Gestational Diabetes in the majority
of clinical situations develops in the range from 16 up to 32 weeks of pregnancy. Features
of carbohydrate metabolism between mother and the child are that the fetus receives
glucose from mother, but doesn't receive insulin. Thus, the hyperglycemia (excess quantity
of glucose) especially in the first trimester when the fetus has still no own insulin, provokes
development of various malformations of a fetus: most often anomalies of a CNS, heart,
bones, a GIT, and urinary tract. After 12 weeks when in an organism of future kid the
insulin is produced, the hyperinsulinemia which threatens with development of an asphyxia
and traumatism in labors, respiratory disorders (a respiratory distress syndrome) and
hypoglycemic conditions of newborns. Adaptation to extra uterine life is slowed down in
the neonatality period. In the neonatal period there are often observed complications from
a CNS, a hypoglycemia, a syndrome of respiratory disorders, a polycythemia, a
hyperbilirubinemia, a hypopotassemia, a cardiomyopathy. Children have a diabetic
fetopathy: the large body weight, a disproportion of a head and a trunk, the puffiness,
excessively developed hypodermically fatty layer, the lunar face, a hemorrhagic rash on
face skin and extremities.
FROM FOLIC ACID TO THE HEALTH OF THE FUTURE BABY
Mikhailova V., Kazakov A. – the 4-th year students
Scientific leaders: Can. Med. Sc. Anokhina R.A., Kostina V.V.
Any woman planning to become mother has to remember that reception of some vitamins
before pregnancy is necessary for health of future kid. One of such vitamins is folic acid
(B9 vitamin). It is water-soluble substance, comes into an organism with food (in a large
number contains in green vegetables and leaves, citrus, bread, liver, cheeses, eggs and
cottage cheese) and can be synthesized by symbiotic bacteria in intestines at a normal state
of microflora. During pregnancy B9 vitamin plays a role in a formation and development
of nervous fabric of a germ, participates in formation of vessels of a placenta. The lack of
folic acid during pregnancy can lead to emergence of uglinesses in violations of mental
development in newborn children. Average daily norm of folic acid – 400 mkg, the most
admissible quantity - 600 mkg. Modern preparations of folic acid contain its necessary
45
quantity, are safe for the pregnant woman in the recommended dosage and are studied
rather well.
Foliber can be applied by women at the time of planning of pregnancy and in the
first three months of incubation of the child to prevention of defects of development.
Gemoferon is applied during pregnancy and a lactation, at anomies, after a stomach
operations, a renal failure, a helminthes invasion. Elevit promotes decrease of risk of
emergence of congenital defects. It isn't necessary to accept for a long time a complex by
persons, with a big amount of calcium in blood.
Folic acid – one of the few medicines, efficiency and which safety at pregnancy is
proved in many researches. Reception only one tablet in day – an easy, inexpensive and
reliable way to reduce risk of serious diseases of the kid and to present it full-fledged life.
HISTOLOGY
OF
THE
NORMAL
GLOMERULONEPHRITIS
Selina I. - the 2nd year student
Scientific leaders - Kozlova V.S., Kostina V.V.
KIDNEY
AND
IN
The kidney is the main organ for the allocation of end products of nitrogen
metabolism, and protecting the constancy of physical and chemical conditions, osmotic
pressure and acid-alkaline balance in the body.
The nephron is the structural and functional unit of the kidney. It consists of the renal
corpuscle, proximal, thin part of the loop, the distal.
The renal corpuscle provides a process of selective filtration of blood, resulting in the
formation of primary urine. It has a rounded shape and consists of a vascular bundle,
covered by two-layer of the glomerulus capsule of Shumlyansky-Bowman. The
glomerulus is formed by 20 - 40 capillary loops. The endothelium of capillaries consists
of highly flattened endothelial cells with fenestrae. The endothelium lies on the threelayered basement membrane common for the endothelial cells and podocytes. The outer
and inner layers in the membrane are bright and medium — dark. In the dark layer there
are microfibrils forming a network. Only very small protein molecules can get in to
urin through these cells. The inner (parietal) wall of capsule nephron consists of a single
layer of podocytes. From the body of the podocyte in all directions a large processes of
cytotrabeculae depart and from cytotrabecula— smaller processes — of cytopodia.
Cytopodia are attached to the basement membrane, between them there are a filtration
slits. The endothelium of capillaries, three-layer membrane and membrane between
cytopodia of podocytes form the filtration barrier through which primary urine is
filtered from plasma. This filter passes water, salts, low molecular weight proteins.
Glomerulonephritis is a diffuse immune inflammation of the glomeruli. Own immune
system of the body, is broken due to a previous infection that causes inflammatory
lesions of the glomeruli, leading to glomerulonephritis. Due to the damage of kidney
filtration removal of fluids from the body is deteriorating leading to edema. Often in
acute glomerulonephritis urination is reduced, or urine itself takes red color from the
admixture of red blood cells. In the absence or inadequacy of treatment
glomerulonephritis leads to progressive chronic renal failure, high blood pressure, to
the poisoning of the body by slag newimagename manifested toxic lesions in internal
organs, particularly the central nervous system and intestines.
46
HISTOPHYSIOLOGY OF RECEPTORS
Andreychenko M. - 2nd year student
Scientific leaders - Kozlova V.S., Kostina V.V.
Thanks to receptors we perceive information about the external environment and
our internal environment. Receptors - a specialized sensory formation, perceiving and
transforming stimuli from the external and internal environment to the specific activity
of the nervous system. There are several classifications of receptors. The position of the
body at an adequate stimulus, according to the structure characteristics: free nerve
endings, not free (encapsulated). Of particular importance to our lives have analyzers.
Recently, however, there are many factors, reducing our ability to perceive. Long and
frequent use of computer technology impairs vision, and the use of headphones - hearing.
Genetic diseases are of great importance where the lack of sensitivity is inherited. Also,
one doesn’t forget about the additional possibility of using our receptors, namely - for
physiotherapy treatment. An example of one of the pathological it’s pain insensitivity
syndrome, it is a genetic disorder characterized by the absence of thermal and pain
sensitivity. Experimentally it was revealed in patients lack of a system of afferent
(sensory) neurons of the first order, that are responsible for pain and temperature
sensitivity. Such patients often do not even notice the serious damage, even in case of
burns or fractures, they will not experience any discomfort.
ACIDOSIS AS A VIOLATION OF THE ACID-BASE STATE OF THE
ORGANISM
Rukosuev E. - the 2nd year student
Scientific leaders - Cand. Med. Sc. Egorshina E.V., Kostina V. V.
Acidosis (from the Latin acidus - Sour) - displacement of the acid-base balance of
the body in the direction of acidity increasing i.e. below pH 7.35. Depending on the
mechanisms of disorders of acid-base equilibrium there is isolated respiratory and
metabolic. Such diseases such as alveolar-capillary dysfunction, neuromuscular disease,
CNS disorders, broncho-obstructive disease, and the effect of drugs which depress the
central nervous system, are accompanied by the development of respiratory acidosis.
These diseases result in increased arterial blood PCO2. As a consequence content of
H2CO3 in the blood plasma is increased. Increased PCO2 also leads to an increase in HCO3concentration of ions in the plasma due to the hemoglobin of the buffer mechanism. The
low pH and increase of plasma concentrations of H2CO3 and HCO3- characterizes
respiratory acidosis. With the decline of blood pH urinary excretion of ammonium salts is
increased. Metabolic acidosis is caused by accumulation in the blood and tissues of
organic acids. Increasing of acidity in the blood is due to the intake of large amounts of
ketone bodies. In response to continued production of ketone bodies (β-hydroxybutyric
and aceto-acetic acid) in the organism the concentration of H2CO3 - proton donor in a
bicarbonate buffer system decreases. Reducing of the concentration of HCO3 is achieved
as a result of the accelerated release of CO2 light. It is associated with metabolic disorders
and is possible for diabetes, fasting, fever, diseases of the digestive tract, in shock.
Metabolic acidosis is manifested in patients with severe diabetes. Metabolic acidosis
acidity of urine and the concentration of ammonia in urine are increased. Lowering of the
pH below 6.8 is the cause of death.
47
BERI – BERI ILLNESS
Yakubovskaya T., Khon A., Shabalina O. – the 3-rd year students
Scientific leaders - Prof. Korshunova N. V., Kostina V.V.
Beri-beri (vitamin deficiency B1) - a disease that occurs due to a lack of thiamine
(vitamin B1) in the human body. Vitamin B1 provides the normal course of the processes
of carbohydrate and fat metabolism. Its deficiency leads to the accumulation in the blood
of pyruvic acid and its increased concentration in the nervous system. The consequence of
this biochemical metabolic disorders are lesions of the nervous system ("dry beriberi") Wernicke's encephalopathy (acute middle cerebral damage), Korsakoff`s syndrome,
polyneuritis, and others, as well as the defeat of the cardiovascular system ("wet beriberi").
The disease may develop acutely or gradually. In acute forms symptoms of peripheral
nerves appear within 24-48 hours: pain along the nerve trunks, paresthesia and weakness
of the distal extremities, disturbance of sensation in the form of "socks" and "gloves"
sluggish paresis and paralysis of hands and feet. Polyneuropathy is combined with a
disturbance of cortical activity, which is manifested by emotional lability, delusions,
Korsakoff`s syndrome. Recovery is possible in timely beginning of treatment. At
prolonged deficiency of thiamine chronic polyneuritis develops.
SURGERY FOR ABDOMINAL WALL HERNIAS
Yakubovskaya T., Darina N. – the 3-rd year students
Scientific leaders – Assoc. Prof., Cand. Med. Sc. Sergienko A.V., Kostina V. V.
Hernia of the abdominal wall or external hernia of the stomach, is called the emergence
of abdominal viscera beneath the skin through a natural opening in the muscularaponeurotic layer or through the hole in the same layer, the result of surgery or injury.
Components of hernia are: hernial hilus, hernial sac and hernial content. Hernial hilus is
called the gap or hole in the muscular-aponeurotic layer of the abdominal wall where
hernial sac goes out. Herniation of the pouch is called a diverticulum of the parietal
peritoneum, penetrating through hernial hilus under the skin. The herniation may be the
contents of the intestinal loops, omentum. Depending on localization there distinguished
inguinal, femoral, umbilical hernia, white line hernia, obturator. Indications for surgery
for hernia are pain, disorders of the gastrointestinal tract, difficulty in physical work,
walking. A vital indication for operation is the infringement of a hernia.
Contraindications: advanced age of patients, especially in the presence of decompensated
forms of cardiovascular and pulmonary diseases, obesity, flabby degenerated tissue,
which do not allow to rely on the strength of the postoperative scar. The goal of surgery
is to remove the hernia and to prevent relapse: the first is obtained by removing the
hernia sac, the second — with the help of plastic closure of abdominal wall defects.
HYPERTENSIVE HEART DISEASE
Kukhno T., Safronova E. - the 3-rd year students
Scientific leaders - Cand. Med. Sc. Perfileva S. S., Kostina V. V.
Hypertensive heart disease-chronic hypertension the main clinical feature of which
is along and persistent increase in blood pressure. It is widely distributed in economically
developed countries experiencing increase of stress of psycho-emotional sphere. Men in
the second half of life are ill more often.
48
Etiology. Hereditary factors and excess salt in the diet plays an important role in
the occurrence of hypertension, in addition to psycho-emotional surge, leading to
disturbance of higher nervous activity such as neurosis and frustration of the regulation of
vascular tone.
The nature of the disease may be benign and malignant. When malignant
hypertension is dominated by manifestations of hypertensive crisis, i.e. a sharp increase in
blood pressure due to spasm of the arterioles. Morphological manifestations presented
corrugation and the destruction of the basement membrane and endothelium original
position it as a stockade, which is an expression of a spasm of arterioles, plasmatic
impregnation or fibrinoid necrosis of its wall and joining thrombosis. Infarcts and
hemorrhage are developed.
In benign hypertension, taking into account the duration of the disease, there are three
stages: 1) pre-clinical stage of hypertension; 2) stage of widespread changes in arterial; 3)
the last stage of hypertensive disease is characterized by secondary changes bodies in
connection with the change of the arteries and impaired circulation intraorganic
TRANSPLANTATION OF THE BRAIN
Homenko A, Gribov A., Sukhorukova V. - the 3-rd year students
Scientific leaders - Grebenyuk V. V., Kostina V.V.
Relevance of this problem is very big. Worldwide many people have serious
diseases of a brain.
Purpose: studying and understanding of a question of transplantation of a
brain, and also acquaintance of students with this problem.
From all sections of medicine transplantology — one of the most difficult
both in the theory, and in practice. Each organ intended for transplantation consists
of several types of tissues, is surrounded with the nerves sending it signals and
accepting reciprocal impulses from the organ and blood vessels. The immune system
of an organism will reject any cell which initially didn't belong to this organism. Thus,
donor organs can not get acclimatized because of immune reaction.
In the head there is the most important organ — a brain and to replace it,
without having damaged, it is almost impossible. In the neck basis in a place of
connection of backbone with the skull the brain passes into spinal. The spinal cord
controls the movements of all muscles below a neck, and it does it on the basis of the
orders coming from a brain. At transplantation of a brain the spinal cord will
inevitably separate from head, and no signals to a trunk and extremities will be able
to pass — therefore, all movements, except a mastication and expression of emotions
mimic muscles, will become impossible. In the opposite direction impulses won't be
transferred too and even if the person will survive after operation, he won't feel
anything, except the face. The nervous tracts going through a spinal cord and
connecting a brain and heart, a brain and lungs will also be broken.
Transplantation of a brain as separate organ is impossible because to take it
from a skull cavity without damage of all elements is unreal. Therefore, before
scientists there is a question of transplantation of the head entirely. The history knows
several examples of transplantations of an animal head.
The brain is difficult human organ up to this day is not up to the end studied.
Its structure and the vital functions are a hindrance for transplantation. Perhaps, new
technologies will help to find safe ways of its transplantation.
49
WOUND MEPHITIC GANGRENE
Gribov A. Sukhorukova V - the 3-rd year students
Scientific leaders – Cand.Med.Sc. Prokopenko A.V, Kostina V.V.
In 1952 Ambroise Paré for the first time described a mephitic gangrene, having called
it hospital gangrene. In domestic literature N.I.Pirogov in detail described its clinical
picture. Synonyms of the term "mephitic gangrene" are: gas, anaerobic and hospital
gangrene, blue or bronze erypsipelas, Antonov fire, gas phlegmon, malignant edema.
By the way the famous literary hero Bazarov, according to the description died of
anaerobic gangrene. On the researches published in «the Clinical Surgery» magazine
for 1987 A. S. Pushkin's death also was caused from a gas infection by a gunshot
wound with fragmentation of the right ileal and sacral bones and injury of muscles of
a girdle of inferior extremity.
Mephitic gangrene — the serious complication of a wound process caused by an
anaerobic microflora, which is characterized by a necrosis of tissues with formation
of vials of gas in them or plentiful treatment by serous and bloody liquid and serious
general intoxication.
Originators of a mephitic gangrene — Cl. perfringens, Cl. oedematiens, Cl.
histolyticum. All of them form spores, transfer boiling within an hour. Microbes meet
in putrefactive organic substances in the earth, in an intestine of animals and men.
Having taken root into tissues, they quickly cause their necrosis, in the presence of
Cl. perfringens with formation of gases, in the presence of Cl. oedematiens — an
edema. In most cases mephitic gangrenes cause not one, but a combination of two or
three microorganisms. Prevalence in tissues of this or that originator also defines an
originality of a clinical picture.
Adequate therapy of mephitic gangrenes represents a difficult complex problem of
etiotropic, pathogenetic and symptomatic character. Medical measures should have
the general and local character, and well-timed and full operations, combined with
use of antibacterial drugs.
HYGIENIC BASES OF THE NUTRITION AS SOURCE OF HEALTH AND
NORMAL PHYSICAL DEVELOPMENT OF SCHOOL AGE’S CHILDREN
Gribov A. Sukhorukova V. – the 3-rd year students
Scientific leaders - Gosteva L.Z, Kostina V.V.
The correct nourishment in the quantitative and qualitative relation — the
most important factor of body height and harmonious development of the child. It is
necessary for adaptation to changed environmental conditions, the high resilience to
illnesses. The need for nutrients of the growing, developing and activly moving child
is very high. At the same time the organism of small children can acquire not every
nutrition. The child's nutrition by the quantity and quality has to correspond to
features of a digestive tract and satisfy the need of the growing organism for necessary
substances.
Hygienic bases of a healthy nutrition of the school student begin with the
correct drawing up the menu on one meal taking, and also for day and for a week.
The menu needs to be diversified and made in every possible way taking into account
daily energy (high-calorie) needs of an organism.
50
The concept "rational feeding" includes administration of feedstuffs not only
for creation of an energy source, but also for providing the optimum metabolism
providing vital activity of organs and tissues, creation of new cells and destruction of
old ones. Processes of exchange include a series of consecutive phases — an
absorption in an intestine, intracellular processes of assimilation, processes of
accumulation and power consumption. In this regard the main feedstuffs — proteins,
fats, carbohydrates, mineral salts, and also biologically active elements of a nutrition
(vitamins) — have to be introduced in certain quantities and have a certain qualitative
structure.
A certain knowledge and abilities from parents organization of school age
children’s. However and school students have to take active part in cooking, purchase
of products and another economic matters.
HPV - A RISK FACTOR FOR CERVICAL CANCER
Khomenko A. – the 3rd year student
Scientific leaders - Prokopenko A.V., Kostina V.V.
In recent years, in Russia, as in many countries around the world, there is increasing
of the incidence of HPV infection. The problem of its diagnosis and treatment attracts the
attention of doctors of various specialties. This is due to the ability of some types of human
papillomavirus (HPV) to initiate the malignant process. Some of these species are the two
types of HPV-16 and -18, cause cervical cancer and precancerous cervical pathological
states.
Human papillomavirus relates to a DNA-containing virus family, commonly known
as Papillomaviridae. The HPV genome is a circular double-stranded DNA molecule length
of about 8,000 base pairs, coated by protein capsid. Capsid is shaped and formed of 72 L1
protein pentamers, with which protein L2 is associated.
To protect against HPV-16 and -18 vaccines are used. Currently there are two
vaccines - "4 Gardasil 'and' Cervarix '. These vaccines can also provide some crossprotection against other less common types of HPV that cause cervical cancer. One of these
vaccines ("Gardasil") also protects against HPV-6 and -11 types that cause anogenital
warts. Results from clinical trials suggest that both vaccines are safe and highly effective
in preventing of HPV-16 infection and -18.
Today, vaccines are a good method of preventing diseases caused by HPV.
HYGIENIC ESTIMATION OF THE POWER OF PRE-SCHOOL AGE
CHILDREN
Denishchik K., Davidova D., Moiseeva S. – the 3-rd year students
Scientific leaders - Prof.Korshunova N.V., Kostina V.V.
Protection and promotion of children's health is a top priority in any society,
because children determine the life potential of society in the future. According to the
Scientific Center of RAMS, no more than 15% of the child population can be considered
healthy. Children of all age groups have the preferential growth of chronic pathology.
The actual power of healthy preschool children affects their nutritional status, it is
a complex clinical, anthropometric and laboratory parameters that characterize the
proportion of muscle and body fat mass. It is found that an insufficient protein intake from
food is a risk factor for the formation of body composition.
51
To ensure the children by quality balanced nutrition in preschool institutions the
"Collection of technological standards, recipes of dishes and food products for preschool
institutions and children's health institutions" should be used.
Nutrition is one of the most important factors, which operates from the moment of
birth to the last days of life and contributes in the formation of health. Quantitative and
qualitative indicators of power define the processes of growth, development and
functioning of the central nervous system, adaptive immunity to infections and unfavorable
environmental factors.
DEVELOPMENT OF BLOOD SERVICES IN THE AMUR REGION
Skripelev A., Nikitina D. - the 3-rd year students
Scientific leaders - Cand. Med. Sc. Volkov L. A., Kostina V. V.
Executive Committee of Amur Oblast on August 29, 1951 decided to organize
in Blagoveshchensk station of blood transfusion. It became operational on 1-st
September of the same year.
The basis was put by doctor-resident of Blagoveshchensk of city hospital
Eugeny Belousov. He pertormed the first operation of blood transfusion in the Amur
region.
In 1934, there was a blood service on the basis of the city hospital. Three fulltime doctors worked with donors. During the year, it managed to collect 7.5 liters of
blood, which helped to save the lives of 20 patients. First blood decided to surrender
physicians themselves and patients relatives.
At the time of the Great Patriotic War the station of blood transfusion from
Blagoveshchensk moved to Svobodniy. For five years it managed to procure 1.5
thousand liters of blood. The number of donors has increased to nearly seven thousand
people.
In 1951, the station received a separate building in Blagoveshchensk. Staff of
it increased up to 17 professionals. Here to the preparation of blood started on March
12, 1952. In the period from 1951 to 1966 three laboratories were opened at the station
- clinical, serological and bacteriological.
Three years after the discovery of the blood service staff began to produce Rh
serum, in 1957 - to preserve the blood, to produce components - native plasma,
erythrocyte, leukocyte and platelet, and in 1959 - a dry plasma.
1991 was marked as the beginning of the organization for the use of
plasmapheresis method for the preparation of blood in plastic containers. Four years
later, donated blood began to check for the presence of hepatitis C virus.
XXI century has brought its innovations in the work of the station - the plasma
was started to send on quarantine by freezing, to produce the filtered blood
components, plasma and platelets by apparatus method. Rates of preparing of the blood
and the number of donors increased.
HEART ATTACK
Skripelev A., Nikitina D. - the 3-rd year students
Scientific leaders – Cand. Med. Sc. Perfilieva S. S., Kostina V. V.
Heart attack - a vascular necrosis, the investigation and the ultimate expression
of ischemia.
52
Form of heart attack: a wedge-shaped, base of the wedge facing the capsule,
and the point - to the body of the gate is formed in the organs with the main type of
blood supply. Irregularly shaped infarcts are formed in organs with collaterae type of
arterial branches.
Depending on appearance there are three types of infarction:
1.White (ischemic) myocardial portion is white-yellow, well delimited from the
surrounding tissue.
2.White infarction with hemorrhagic rim portion represented by white and
yellow, but the plot is surrounded by a zone of hemorrhage.
3.When red (hemorrhagic), myocardial necrosis land soaked in blood, it is dark
red and is well demarcated.
In the heart an infarct is usually white with hemorrhagic rim, has an irregular
shape, more common in the left ventricle and the interventricular septum, rarely - in
the right ventricle and atrium.
In the brain, a heart attack occurs more often white, which quickly softens. If a
heart attack is formed on the background of significant disorders of blood circulation,
venous stasis, the necrosis of the brain center is impregnated with blood and becomes
red.
Hemorrhagic infarction in the lungs is formed in most cases. It is well delimited,
it has the shape of a cone whose base faces the pleura.
Causes of heart attack - a long spasm, thrombosis or embolism of the arteries,
as well as a functional body of the voltage in low its blood supply. Insufficiency of
anastomoses and collaterals has great importance for the occurrence of infarct .
TYPES OF NOURISHMENT
Nikitina D., Skripelev A. - the 3-rd year students
Scientific leaders – Prof. Korshunova N. V., Kostina V. V.
The basic idea of a healthy diet, "you need to eat everything but in extent". A
"measure" is defined by the so-called "food pyramid", in which all products are
divided into several categories. Products in each category should be represented in
the diet in a certain proportion.
The basic idea of a separate food - do not eat at the same time incompatible
with each other products. All components of food are divided into 3 groups - proteins,
fats and carbohydrates. Fats are compatible with almost all kinds of products. A protein
and carbohydrates with each other can not be combined as needed for the digestion of
proteins acidic environment, and for carbohydrates - alkaline.
Vegetarianism and its subtypes: lactovegetarianism and ovovegetarianism prohibit the eating of animal flesh. The main benefits of vegetarianism is in the
reduction of the share of products of animal origin and increasing the proportion of
plant foods.
Veganism - kind of nutrition that excludes the use of all animal products.
Raw food eating only raw food. Sometimes it can be vegetarian (with milk and eggs)
and omnivorous (meat, fish, seafood, milk, eggs - only raw or dried form).
Fruitarianism - consume only fruits and vegetables. No grains or legumes or
nuts are included in their diet.
53
Ayurvedic meals - the ancient Indian system of healing. It provides not only a
specific range of products or a combination them, but also a meal, climate, time of year,
the type of human digestion.
The liquid food - liquid nourishment juices and soups.
Prana eating - absolute refusal of food consumption, and in the most advanced
form, and from the water.
WILSON-KONOVALOV'S ILLNESS
Yakubovsky T., Darina N. – the 3-rd year students
Scientific leaders – Cand. Med. Sc. Perfilyeva S. S., Kostina V.V.
Wilson-Konovalov's illness (hepatolenticular degeneration) is the autosomal and
recessive disease which is characterized by copper binding disturbance that leads to
cirrhosis, a degeneration basal ganglions, an olive-brown pigmentation on a cornea
(Kayser-Fleischer's ring). The lesion of a liver can be shown by one of four options:
acute hepatitis, fulminant (malignant) hepatitis, chronic active hepatitis or early
cirrhosis. The quick release of copper from a liver at malignant hepatitis causes
developing of hemolitic anemia characteristic of this pathology. Motive disturbances
are typical and characterize a lesion of a nervous system. On the contrary mental
disturbances are diverse and are shown by asocial behavior, schizophrenia, neurosises,
a dementia. When conducting laboratory tests depression of level of a ceruloplasmin
in blood, rising of a daily content of copper, rising of content of copper in a liver at a
biopsy are defined. Treatment consists in binding of excess of copper DPenicillaminum, or thriethylene melamiae dihydrochloride. At the malignant course of
a disease there may be performed the orthotypical liver transplantation.
ATYPICAL FORMS OF MYOCARDIAL INFARCTION
Shabalina O., Khon. A. – the 3-rd year students
Scientific leaders – Cand. Med. Sc. Menschikova N.V., Kostina V.V.
The peripheral shape with atypical localization of different localization of pain in
the throat, pain in the left hand end of the left little finger, left shoulder blade, in the neck
and thoracic spine, the lower jaw. Abdominal form is usually found at the back myocardial
infarction. There intense pain in the epigastric or right upper quadrant, the right half of the
abdomen, accompanied by nausea, vomiting, abdominal distention, paresis of the stomach
and intestines, diarrhea. Asthmatic form flows by type of severe breathlessness, cough with
frothy pink sputum (cardiac asthma, pulmonary edema) in the absence or low intensity of
pain in the heart. At the same time there is a gallop rhythm, arrhythmia, drop in blood
pressure. Arrhythmic form is characterized by the appearance of different rhythm
disturbances (arrhythmias, atrial fibrillation, paroxysmal tachycardia), as well as different
types of atrioventricular block. Cerebral form appears clinic dynamic cerebral circulatory
disorders - headache, dizziness, nausea, vomiting, less motor and sensory disorders.
Insufficiency of cerebral blood supply occurs against a background of atherosclerotic
lesions of cerebral arteries due to a decrease in cardiac output, which is typical for acute
myocardial infarction. Edematous form of myocardial infarction is manifested by shortness
of breath, weakness, a relatively rapid swelling and even ascites, the liver increases - that
is, acute right ventricular failure develops.
54
TOURETTE SYNDROME
Khon A., Shabalina O. – the 3-rd year students
Scientific leaders - Cand. Med. Sc., Assoc. Prof. Maximenko V.A., Kostina V.V.
Tourette syndrome (Tourette's disease, Gilles de la Tourette Syndrome) - a
genetically caused disorder of the central nervous system manifestation in childhood,
characterized by multiple motor tics and at least one vocal tic.
A person with Tourette syndrome has a 50% probability of gene transfer
(gene) to one of his child, but Tourette's syndrome - a condition with variable
expression of genes with incomplete penetrance. Thus, not everyone who inherits the
genetic defect will manifest symptoms; even among close relatives may show
symptoms of varying severity, or even cannot be. Gene (s) can be expressed in
Tourette's syndrome as teak mild (transient or chronic tics) or obsessive-compulsive
symptoms without tics.
Non-genetic, environmental, infectious, or psychosocial factors which
cannot cause Tourette's syndrome, but can affect its severity. Autoimmune processes
may provoke the emergence and exacerbation of tics in some cases.
Genetic and environmental factors play a role in the etiology of Tourette's syndrome, but
the exact causes are unknown. In most cases, treatment is`t required. There are no
effective drugs for each case of ticks, but the use of medicines and treatments that
facilitate the patient's condition, is justified. Education, explanation is an important part
of psychological support for patients.
METHODS OF IDENTIFYING DETERMINANTS OF ANTIBIOTIC
RESISTANCE
Kozyrev V., Pernitskiy S. - the 3rd year students
Scientific leaders - Cand.Med.Sc. Bubenets O.V., Kostina V.V
To determine the resistance of gram-negative microorganisms in beta-lactam
antibiotics it is necessary the study of nucleotide sequence encoding beta-lactamase
genes to identify the type of genes and the presence of mutations.
Multiplex of RC of DNAm: for amplification of several genes multiplex it is
simultaneously used (multiprimer) PCR reaction co-amplification of several DNAmatrix in the same reaction medium using several pairs of primers.The method allows
to identify the identity of the gene of the enzyme to a specific type of beta-lactamase.
Method time-of-flight mass spectrometry : an alternative to existing methods
for detection of polymorphous DNA regions is differential sequencing by using timeof-flight mass spectrometry. The ionized molecules of DNA detached from the
substrate by the methods of MALDI , is accelerated in an electric field and are
directed through the vacuum chamber to the detector.The method is characterized by
high productivity and possibility of simultaneous analysis of several samples. The
undoubted advantages of the method include the ability to detect new, still
undescribed mutations.
DOWN SYNDROM
Kozyrev V., Pernitskiy S. - the 3rd year students
Scientific leaders - Krylov A., Kostina V.V.
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Down syndrome (Down's Syndrome) is the result of genetic anomalies. The first
signs of people with Down syndrome, described in 1866 English physician John Langdon
Down (Down), whose name was the name for this syndrome. The cause of the syndrome
was discovered only in 1959 by the scientist Jerome.
The syndrome occurs due to the differences of chromosomes during the formation
of gametes (eggs and sperm), as the result that the child receives from the mother (in 90%
of cases) or father (10% of cases) the spare 21st chromosome. Most patients with down
syndrome have three 21-x chromosome instead of two; in 5 8% of cases the anomaly is
related to the presence of not a whole, spare chromosome, its fragments.
Modern methods of research - Screening
The first stage of the procedure "screening" – is an ultrasound examination of the
fetus. The compliance of the size of the baby to gestational age during it evaluate. The
general condition of the embryo, some severe defects in the development and so on. That
is what can be seen externally. But it is worth noting that even if the apparent abnormalities
are not observed, this does not mean that there no them. For example, kids suffering from
down's syndrome, only half of the cases it is possible to notice visual abnormalities. A
more accurate result of the presence of chromosomal diseases can only be obtained after
the second stage screening – biochemical. Here the blood of the mother examine for the
presence of specific substances that is released by the placenta. Also the ratios and
concentrations of specific proteins in the blood and marker substances evaluate. Third stage
– calculating the risk of chromosomal abnormalities with the help of special computer
programs.
THE ENDOSCOPIC PLASTIC ARTS. TREATMENT OF SOME CARDIAC
ANOMALIES
Pronina D., Chervova Y. – the 3rd year students
Scientific leaders – Cand.Med.Sc., Assoc. Prof. Sergienko A.V., Kostina V.V.
One of the latest developments inculcated in cardiac surgery practice are little
invasion operative technologies - found the application in the correction of congenital heart
diseases. It is the most sparing methods, allowing to lead an operating trauma to the
minimum, execute interference without connecting of patient to the heart-lung apparatus,
to unite a few stages in one, to reduce the amount of complications and substantially to
facilitate the flow of rehabilitation (restoration) period.
For similar interferences front-rank endoscopic technologies are used, supposing
application of the special devices - endoscopes. The last are the very flexible, thin and
long tubes, equipped by the optical system and source of light. Due to endoscopes, any
damage of fabrics and internals is taken to the minimum: cuts replace quite small
punctures; here the vital functions of organism do not suffer practically
PROBLEM OF OBESITY IN THE MODERN WORLD
Pronina D., Chervova Y. – the 3rd year students
Scientific leaders – Cand.Med.Sc. Matytsin A.P., Kostina V.V.
It is considered that the person has obesity if its weight exceeds normal more than
for 20% and continues to increase further. More than a third of adult population of Russia
has this illness. According to WHO statistics, in economically developed countries about
30% of adults and up to 10% of children have this or that form and degree of an obesity.
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For the last decade the number of such patients in the world increased almost twice and
according to experts in 2025 their quantity will make 300 million people. Every year the
number of the young people having obesity increases, the common life expectancy of the
population of the globe in connection with the serious illness accompanying an obesity
decreases.
At an obesity proteometabolism which is characterized by decrease in level of the
common protein of blood mainly due to decrease of concentration of albumins, increase
in maintenance of a fibrinogen, fibrin degradation products, decrease in level of a
heparin. Violation of transport of lipids, decrease in fibrinolytic activity and increase in
thrombogenic properties of blood, emergence of tromboembolic episodes is a
consequence of it. These changes are risk factors of an atherosclerosis, coronary heart
disease, stroke, idiopathic hypertensia. There are violations of functions of the central
nervous system: fatigue, drowsiness, memory impairment are noted; the senilism
develops, there are changes in internals, for example a fatty infiltration (an obesity or
fatty transformation) of a liver
TUMORS OF THE MELANIN FORMING TISSUE
Pronina D., Chervova Y. – the 3rd year students
Scientific leaders – Cand.Med.Sc. Levchenko N. R ., Kostina V.V.
Melanocytes are ancestors of the most malignant tumor of the person and animals –
a melanoma. Considering the important place of melanocytes in a regulation of a
homeostasis and development of pathology, questions of studying of a melanogenesis and
its histologic diagnostics take the increasing value.
Melanocytes are cells of a neurogenic origin which can be a source of tumorous
manifestations - a nevus, and the true tumors - melanomas. A nevus meets in skin, on a
face, trunk in the form of convex formations of dark color. Several types of a nevus are
distinguished: the boundary nevus, the intra dermal nevus, the composite nevus,
the epithelioid nevus, the blue nevus.
Melanoma (melanoblastoma, malignant melanoma) - a malignant tumor of the fabric
forming a melanin, one of the most malignant tumors with the expressed tendency to an
innidiation.
THE SPECIES COMPOSITION OF THE VAGINAL LACTOBACILLI IN
PREGNANT WOMEN
Pronina D., Chervova Y. – the 3rd year students
Scientific leaders - Prof. Chubenko G.I., Kostina V.V.
According to the data of literature there was the analysis of the species composition
of lactic acid bacteria in various states of the vaginal microbiota of women in the II and III
trimester of pregnancy [A.R. Melkumyan, T.V. Priputnevich et al .; -2013].
They were screened 163 women. Status microcenosis was rated as normocenosis in
36.8% of women, while 63.2% were diagnosed various options for vaginal infections.
Candida vaginitis in 21.9% of patients, aerobic (non-specific), vaginitis (AV) are
associated with facultative anaerobic opportunistic pathogens - in 14.2%, bacterial
vaginosis (BV) - in 16.8% of pregnant women and others.
In inoculations of vaginal discharge of pregnant women with normocenosis 8
species of Lactobacillus have been identified in high titer. The leading position occupied
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by 3 species: L. crispatus (63,2%), L. jensenii (33,4%) and L. gasseri (17,5%). In 54.4%
of pregnant women there were allocated opportunistic microorganisms in low titers.
Frequency of inoculation remaining 5 species - L. fermentum, L. salivarius, L. mucosae L.
delbrueckii, L. plantarum was less than 5.3%.
When BV there was noticed an increase in a wide range of facultative anaerobic
opportunistic microorganisms. Coagulase-negative staphylococci, Corynebacterium and
actinomycetes have dominated. The growth of lactobacilli is found in pregnant women
with BV in 80.6% of cases, but in low titers. 15 species of lactobacilli are allocated: L.
crispatus, L. jensenii, L. gasseri, and others.
In women in the group with aerobic vaginitis (AB). Enterococcus faecalis,
Escherichia coli, Streptococcus agalactiae, Staphylococcus aureus prevailed in a high titer.
An analysis of the species composition of vaginal lactobacilli isolated from pregnant
women with normocenosis, confers a presumption of dominance species L. crispatus
indicator of norm stability of microecology vagina.
PREVENTION OF COLD EFFECT ON HUMAN BODY. HARDENING
Pronina D., Chervova Y. – the 3rd year students
Scientific leaders - Prof. Korshunova N.V., Kostina V.V.
Hardening - physiotherapeutic method for effects on the human body of different
natural factors: air, water, sun, low and high temperatures (relative to body temperature)
and reduced atmospheric pressure, with an aim to improve the functional organism’s
reserves and it is resilience to the adverse effects of these factors. The systematic
application of hardening procedures reduces the number of colds in 2-5 times, and in some
cases, almost completely eliminates them. Hardening may be specific (increased resistance
to certain factors) and nonspecific (increases overall resistance to a number of factors). At
starting of hardening, it is necessary to learn its basic rules:
1. It is necessary to verify the necessity of hardening and raise the need for it.
2. Hardening should be systematic.
3. You cannot change sharply the temperature of the water or air, as well as to
increase the duration of exposure.
4. Individual approach - air or water temperature, duration of the procedure shall be
established taking into account age, gender, health status, level of physical development,
sensitivity to cold or heat.
5. In each climatic region, hardening must be specific.
6. To increase the effectiveness of hardening is necessary to use various means solar radiation, air and water environment.
7. Hardening should be fun, it should be carried out in a good mood, because
positive emotions completely eliminate the negative effects of heat or cooling steps.
8. The efficiency of hardening will increase if it is performed in the active mode,
i.e. to perform procedures during exercise or any physical work.
9. In the process of hardening it’s required constant self-control. Indicators proper
hardening are: deep sleep, good appetite, improve health, increase efficiency. The
emergence of irritability, decreased appetite, decreased performance indicate errors in
hardening procedures.
Hardening should be seen as an attempt to bring the human way of life to the natural,
to keep congenital adaptive abilities of an organism.
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IMPLANT INFECTION PREVENTION
Pronina D., Chervova Y., Shebunova V. – the 3rd year students
Scientific leaders – Ivanova E.P., Kostina V.V.
Meaning of antiseptic and aseptic techniques in the development of surgery can’t be
overemphatic. They have enhanced the volume of surgical interventions and surgery
penetrate into all areas of the human body.
Prevention of implant infection – ensuring of strict sterility of all alien artificial
materials and devices with a specific medical purpose, introduced into the body of the
patient.
Sutures can be administered in the body of the patient, also catheters and drains,
prosthetic heart valves, blood vessels, joints, various metal constructions (brackets,
scrapers, screws, needles, plate osteosynthesis), spirals, Steptoe, transplanted materials. All
implants must be sterile. Sterilization method may be different, depending on the material
structure. The main, most reliable method in practice is a factory beam sterilization.
The classic way to silk sterilization (Kocher method) and catgut (method of
Gubarev) are currently not applied because of the complexity and sufficient efficiency. In
the hospital nylon is now only sterilized, polyester and metal braces. There are sterilized
by autoclaving. The rest of the suture is sterilized beam prefabricated; it is available in vials
and containers. After sterilization, or opening packages suture material is stored only in
96° ethyl alcohol.
Various prosthetic design and are available in hermetically sealed sterile packages.
Allogenetic organs may become a source of transplant surgery. Sterilization
transplant is not possible. After removal from the donor organism and washing by sterile
solutions the organ is placed in a special sealed sterile container and stored in special
compartments before transplantation.
BIOLOGICAL ACTIVE FOOD
Baldanov E., Darina N. – the 3-rd year students
Scientific leaders – Prof. Korshunova N.V., Kostina V.V.
The evolutionary meaning a nourishment is to use a varied diet with nutritional
value (proteins, fats, carbohydrates, dietary fiber, vitamins, minerals). The biological value
of food is determined by the availability of essential nutritional factors, they are not
synthesized in the body or synthesized in limited quantities and with low speed. The main
essential components of food are 8-10 amino acids, 3 — 5 polyunsaturated fatty acids, all
vitamins and most minerals as well as natural physiological substances of high biological
activity: phospholipids, protein-lecithin and glycoproteins complexes.
LAPAROSCOPIC CHOLECYSTECTOMY
Smirnova A., Mirgyan R. - 3rd year students, Poroshin A. – 6th year student
Scientific leaders - Assoc. Prof., Cand. Med. Sc. Sergienko A.V., Kostina V.V.
The first laparoscopic cholecystectomy in persons was performed by Ph. Mouret
(Lyon, France) in 1987 and then received a quick distribution and recognition in the
developed world. Laparoscopic cholecystectomy combines radicalism (removed the
diseased gall bladder with calculi) with small traumatic (almost completely preserved the
integrity of the soft tissues of the abdominal wall, especially muscle and fascia), which
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considerably reduces recovery times of patients disability. Gallstone disease is more
common in women, often before the age of 30 - 40 years old, great importance has the
cosmetic effect of intervention - small skin incisions (5-10 mm) heal with the formation of
scars inconspicuous. Laparoscopic cholecystectomy has advantages before
cholecystectomy from a small (5-6 cm) laparotomy incision, used by some domestic and
foreign surgeons. A small section of the anterior abdominal wall limits the inspection and
manipulation in the depth of the wound, especially in the allocation of the neck of the
gallbladder elements. When cholecystectomy under laparoscopic control intervention
scope, as a rule, even better compared to the operation of a large laparotomy incision,
particularly in relation to cystic duct and artery of the same name. In addition, during
laparoscopic surgery it is possible atraumatic inspection and, if necessary instrumental
revision of all the organs of the abdomen and pelvis. When a co-morbidities (chronic
appendicitis, ovarian cysts are small, and others.) a second operation may be performed
after completion of the primary intervention. The advantages of laparoscopic
cholecystectomy have made it even now the main method of treatment of calculous
cholecystitis in many countries around the world, including in our country.
MECHANISMS OF THE INFLUENCE OF CATECHOLAMINES ON IRON
METABOLISM
Mirgyan M. – the 4th year student., Mirgyan R., Smirnova A. – the 3rd year students
Scientific leaders - Cand. Med. Sc. Matytsin A.P., Kostina V.V.
Many human somatic cells can simultaneously interact with hundreds of symbiotic
microbes, which allows to say about microecological human system. Based on modern
science data, which consider the relationship between higher animals and microorganisms.
In the works of Ugolev it is described "natural technology of biological systems" that are
of interest to the detailed study of the effect of neurotransmitter amines such as
catecholamines on the growth of microorganisms. During the last 15 years there were
accumulated evidence suggested that the ability to actively use the neurohormonal products
host of physiological reactions, such as catecholamines, as an environmental stimulus for
the growth and implementation of the biological activity was widespread among bacteria.
It is experimentally proved that the absence of free iron in the medium inhibits the growth
of bacteria culture and the realization of their pathogenic properties, so there is a strong
correlation between the availability of iron ions and the virulence of the microorganism. In
the intestinal mucosa and lungs, which is the primary line of defense of the body against
the microflora, low levels of iron determines the inhibition of pathogen growth. According
to studies it is known that in mammals the iron ions are in a bound state, which means that
the primary mechanism of nonspecific defenses against microbial infection.
Сatecholamines can release iron from transferrin, which facilitates the subsequent intake
of iron microorganisms inwardly and as a consequence, increases sharply bacterial
virulence. Studying the role of catecholamines effects on the body, the effect of free iron
on the virulent properties of the organism contributes to the fact that a key element
emphasize the innate host defense system to attack pathogens and viruses and to develop a
more advanced method of treatment, in order to avoid various complications.
MODERN METHODS OF TREATMENT OF INTESTINAL DYSBIOSIS IN
CHILDREN
Smirnova A., Mirgyan R. – 3rd year students
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Scientific leaders - Cand. Med. Sc. Prokopenko A.V., Kostina V.V.
Gastroenterologists on the results of fecal analysis, establish a diagnosis - intestinal
dysbiosis, the symptoms of which are expressed in diarrhea, constipation, nausea, weight
loss, in children - the occurrence of allergic reactions, anxiety, abdominal pain and etc. In
children, depending on the age of the normal intestinal microflora in the 85-98% is
represented by bifidobacteria, as it contains Lactobacillus, Escherichia coli, Escherichia,
Clostridium, Staphylococcus, Streptococcus. Some of these bacteria - helpful: they help
digest food, synthesize vitamins, contribute to the good functioning of the immune
system and perform other important functions in the body. Dysbiosis risk factors include:
the latest breastfeeding, bottle-feeding, malnutrition. The basis for the correction of
dysbiosis is proper nutrition, prolonged breast feeding, introduction of complementary
foods in the time. Medicinal agents include drugs containing microorganisms representatives of the normal flora (liquid and dry "Bifidumbacterin" "Lactobacterin"
"Lineks", etc.); agents that are nutrient medium for the growth of bifidobacteria and lactic
acid bacteria and stimulate their proliferation ("Hilak forte", "Lysozyme", etc.),
bacteriophages, in some cases treatment begins with antibiotic with subsequent correction
of probiotic microflora. Immunomodulators to accelerate the recovery of the intestinal
microflora, can be applied only on prescription, it will be better to use herbal
preparations, such as Propolis, Dibazol, Immunal, tincture of echinacea, lemongrass,
Eleutherococcus. Not to permit the development of dysbiosis will allow the timely and
proper treatment of chronic diseases of the digestive system, against the background of
which there may be an imbalance of intestinal microflora.
THE USE OF OZONE FOR THE TREATMENT OF PURULENT WOUNDS
Poroshin A. - 6th year student, Smirnova A., Blagova Zh., Mirgyan R. – 3rd year students
Scientific leaders - Dr.Med.Sc. Volodchenko N.P., Ivanova E.P., Kostina V.V.
The problem of treatment of inflammatory diseases occupies a leading position in
the surgery due to the steady increase in the prevalence and increase in the percentage of
complications and mortality. The frequency of inflammatory complications, even after
"pure" planning of operations is quite high (5 to 35% according to the literature and has a
tendency to increase. Despite the widespread use of modern highly effective antibacterial
drugs in patients with purulent surgical infection, the results of treatment of these diseases
often remain unsatisfactory (slow recovery, relapse, superinfection, etc.). Often this is due
to the fact that pathogens of purulent infections are highly resistant to the action of the
antibiotics and antiseptics. This concerns the agents of nosocomial infections. In
connection with this growing interest of surgeons to use in the treatment of inflammatory
diseases of natural physical factors and chemical substances grows. One of the physical
factors is ozone. Its anti-inflammatory effect is due not only high bactericidal and antiviral
activity. Ozone significantly modulates prostaglandin system - unconditional conductors
of inflammation. Furthermore, it was found that it increases the activity of glutathione
system forming intracellular antioxidant protection against free radical reactions.
Ozonation tissue carries anti-inflammatory effects by the of influence on the synthesis of
biological conductors of phagocytes inflammation. Also, ozone has a pronounced antihypoxic action. When hypoxia tissue ozone restores oxygen-transport function of blood.
As a result, it improves oxygenation of tissues. Ozone is a highly effective non-specific
treatment of surgical infection, which can be used both independently and in combination
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with conventional treatments. The use of ozone accelerates the timing of cleansing and
healing of wounds, reduce the time of hospital stay, reduce the amount or dose, to give up
out of antibiotics. Ozone therapy provides a simple and economical method of treatment
and, at proper selection of doses, does not give side effects and complications.
EPSTEIN-BARR VIRUS
Blagova Zh. – the 3rd year student
Scientific leaders - Cand. Med. Sc. A.V. Prokopenko, V.V. Kostina
Epstein-Barr virus - one of the most diffused viruses in the human population. Like
most herpes viruses, Epstein-Barr virus can not be eliminated completely that’s why every
person that was infected, remains the carrier and a potential source of virus infection. The
virus was discovered and described in 1964 by two British virologists - Michael Epstein
and Yvonne Barr. Epstein was a professor at one of the British institutions, and Barr
worked as his assistant. The virus genome is represented by the double-stranded DNA
virus, it has not RNA level in its replication. The main way of getting this infection is
kissing. The largest number of viral particles are in the epithelial cells around the salivary
glands and a larger number in saliva. The virus affects primarily epithelial cells of the
mouth, throat, tonsils, and salivary glands. Here it reproduces the most active. The main
quality of this virus is that it does not slow down and does not violate the proliferation of
cells, it makes their proliferation stronger. As a result, in the acute phase of infection
increases the number of lymphocytes, they fill the lymph nodes, causing them to swell and
seal. In order to identify Epstein-Barr virus in the early stages of its development,
microbiologists use a few basic diagnostic methods: serological diagnosis to determine the
titer of IgM antibodies. The titer of 1:40 is already diagnostically significant; determining
the titer of specific antibodies to the virus. This method is especially important for children,
who do not have heterophile antibodies. By the way, after getting this virus, level of
specific IgG titer remain high for the whole life. Linked immunosorbent assay, PCR,
cultural methods are also widely used for diagnostics.
OPERATIONS IN THE VEINS: HISTORY, THE CURRENT STATE OF THE
QUESTION
Shebunova V., Blagova Zh., - the 3rd year students
Scientific leaders - Assoc. Prof., Cand. Med. Sc. Sergienko A.V., Kostina V.V.
In ancient times surgeons faced with damage of the main veins, which could lead
to death. Damage of the main veins occurs in trauma, with the defeat of vascular
inflammation, occlusion of veins surrounding tissue tumors, in the first place of the reasons
for surgery on the veins is the blood clot. That is why the operation on the veins in modern
vascular surgery plays an important role. Modern vascular surgery refers to a type of
minimally invasive surgery. Modern technologies allow to carry out operations inside
blood vessels, which is indicative of intravascular or endovascular surgery. The main
feature of endovascular surgery is that all interventions are made without cuts - through
small punctures in the skin (tool 1-4 mm in diameter) under X-ray control. X-ray inspection
is carried out by using high-tech equipment (angiographic apparatus) in special roentgen
operated rooms. The main methods used by endovascular surgeons to treat a variety of
diseases of the veins include: endovasal laser photocoagulation; miniflebectomy;
installation of cava filters; radiofrequency ablation.
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MYOCARDIAL INFARCTION. ETIOLOGY
Bayramov M., Mirgyan R. – the 3rd year students
Scientific leaders – Cand.Med.Sc. Levchenko N.R., Kostina V.V.
Myocardial infarction can be started in the most unexpected moment. Violation of
the integrity of the plague can be provoked by palpitations, hypertension, psychoemotional
overexertion and physical activity. The appearance of cracks in the atherosclerotic plague
results in the deposition on it activated platelets and erythrocytes. These processes start the
process of blood clotting and thrombus formation. It can quickly grow and the artery begins
to narrow sharply. Typically, the time of clot formation until complete obturation
(occlusion) of the coronary artery runs about 2-6 days. The main cause of myocardial
infarction is significant breach in the arterial blood vessels of the heart, wich leads to
ischemia (inadequate flow of blood) of a section of the heart muscle and provokes the death
of myocardial cells.
HYGIENE OF CHILDREN’S SKIN
Mirgyan R., Arkhipov S., Bayramov M. - the 3rd year students
Scientific leaders – Prof. Korshunova N.V., Kostina V.V.
The skin of children, as well as the entire body, from the moment of birth until the
onset of puberty is in the organic and functional development. Significant impact on the
physiology and pathology of the skin in different periods of childhood have a hereditary
and social factors, metabolism, immune system and others.
Skin muscles in children are not well developed, the epidermis is thin, connective
tissue fibers are underdeveloped - this leads to increased irritability of nerve receptors. But
small children’s subcutaneous fat differs by loose epidermis.
Sweat glands are beginning to show its activity gradually to 2 years old of a child’s
life, and only at puberty there occurs sweating on the adult type.
The sebaceous glands in children bigger, they atrophy progressively as the child
grows, but not on of them.
The circulatory system of children is characterized by increased vascular
permeability, which is visible through the thin epidermis. This factor and underdeveloped
dermis cause the pink-pearl skin of color children.
Anatomic failure of children's skin in the form of abundant vascularization,
increased hydrophilicity and lack of connective tissue structures - resulting in imperfect
protection of the skin. Also children's skin is characterized by a decrease of bactericidal
properties of the sebaceous and sweat glands, and water-lipid mantle has neutral and
slightly alkaline reaction. This causes easy vulnerability of children's skin, a tendency to
the formation of cracks, scratches, etc.
TECHNOLOGY OF FAST TRACK-SURGERY
Bayramov M., Arkhipov S. – the 3rd year students
Scientific leaders – Ivanova E.P., Kostina V.V.
The founder of the multimodal fast track program in Europe, covering all phases of
perioperative care, is Professor H. Rehlet. Konstantin Puchkov introduced great
importance in the development of this technology.
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Preoperative strategy: Patient education - a real explanation and information about
the upcoming medical procedures, surgery, postoperative, fast track program benefits, limit
of nutrition before the operation. The need for mechanical intestines preparation is not
considered reasonable to surgery.
Intraoperative Strategy: Anesthesia, which reduces surgical stress to a minimum.
The use of minimally invasive surgical techniques to reduce the inflammatory component
of the stress response; optimized infusion therapy; providing of intraoperative
normothermia.
Postoperation strategy: Effective pain relief. Early oral hydration. Early restoration
of enteral nutrition (6 hours after surgery). Rapid mobilization.
LAPAROSCOPIC TREATMENT OF ALLOWED ECTOPIC PREGNANCY
Arkhipov S., Bayramov M. – the 3rd year students
Scientific leaders – Assoc. Prof., Cand.Med.Sc. Sergienko A.V., Kostina V.V.
When laparoscopic treatment of ectopic pregnancy a radical (salpingectomy) and
organ-saving operations are performed.
Salpingectomy. The operation was performed from 3 accesses: one 10-mm for the
laparoscope and two - a 5- or 10-mm - for tools.
Conserving surgery. Types:
1. Laparoscopic linear salpingotomy.
2. Segmental resection of the pipe.
3. Extrude of the ovum of ampullar tube division.
Laparoscopic linear salpingotomy:
1. Dissection of the tube.
2. Remove of ovum.
3. Rehabilitation of the tube.
4. The final phase of the operation. Lavage of the pelvic cavity, aspiration of blood and
clots.
Segmental resection of the pipe:
1. Sanitize the abdominal cavity and pelvic cavity, removing of blood and clots.
2. The section of tube with the fetal egg captures by atraumatic clamp and lifts upward to
visualize mesosalpings.
3. Using scissors to cut tissue along coagulation line.
4. Closer to the wall of the fallopian tube coagulates and crosses mesosalpings.
5. Section of tube is removed by one of the above methods.
EDUCATION INTOXICATION MECHANISM
Arkhipov S., Bayramov M. - the 3rd year students
Scientific leaders – Cand.Med.Sc. Matytsin A.P., Kostina V.V.
With increasing concentration of ethanol in the blood firstly cells of the cerebral
cortex react on it, then the medulla and spinal. Spinal reflexes are affected only at a very
deep intoxication. When the content of alcohol in the blood of less than 30 mg% of its
apparent effect on the body is absent. Absolutely lethal concentration of 500-800 mg%
(with individual variations).
The main effect of the influence of alcoholic beverages on the central nervous
system - disregulating. At moderate intoxication its two stages are manifested by:
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excitation and inhibiton. At high doses the first stage is almost atsent. In the first stage,
when a person experiences a state of euphoria, bioelectric processes in the brain are
activated, EEG α-rhythm disappears, there is a spike activity, reaction to stimuli are
enhanced.
In the second stage, when there is braking, electroencephalogram indicates
generation of -rhythm, slow waves appear, the reaction to stimuli is inhibited. All this
shows that at the intoxication of large degree the tone of the reticular formation of the brain.
NON-FREE SKIN PLASTY
Fomina E. - the 3-rd year student
Scientific leaders - Ivanova E.P., Dr.Med.Sc. Volodchenko N.P., Kostina V.V.
Non-free skin plasty is divided into two types: 1) the closure of the wound by
making use of the adjacent skin with or without additional cuts; 2) wound closure by
moving the skin flap on the leg, taken near the wound or from distant parts of the body.
Regional skin plasty.
1. Closure of the skin defect in usual way after the mobilization of the surrounding tissue
from the muscle fascia;
2. Using laxative incisions around the defect;
3. Scalloping rotating tongue-shaped flap of skin from lying next to healthy skin - carved
out flap is placed over the defect and fix.
4. Z –shaped, or plastic counter triangular flaps (A.A.Limberg’s method).
Distantly related skin plasty.
1. Method of pedicled flap. The main indication for the use of pedicled flap are limb
defects. The advantage of the method is that extensive skin and subcutaneous defects can
be closed in a relatively short period of time (12 - 18 days).
2. The method of bridge flap. At the plastic flap bridging the latter receives nourishment
from the maternal soil on both sides. There produces two parallel incision and mobilization
of the skin - to form a "bridge", under which the defect is placed and the flap is sutured to
the edges. After engraftment of flap cutting off his maternal soil is performed.
3. Method of dermal-fat flap including artery. This method provides a microsurgical
technique, a special ultra-thin suture material for applying of vascular anastomoses. It is
used for closing defects of the fingers, replacing the fingers, with extensive defects of the
feet, hands, neck and face.
4. Plastic round migrating stalk flap. There produce two parallel incision of the skin and
subcutaneous tissue to the muscle fascia. Mobilizing the flap of the fascia the edges are
sewn together, thus forming a skin cylinder. Place of takitaking of flap is sutured by
separate bundle seam.
THE PATHOPHYSIOLOGY OF ALZHEIMER’S DISEASE
Sadykova A., Pronin V. – the 3-rd year students
Scientific leaders – Cand. Med. Sc., Assoc. Prof. Maximenko V.A., Kostina V.V.
Alzheimer's disease - the most common form of senile dementia, occurring
usually at age of 60 years old. It has been established that Alzheimer's disease is
proteopathy - a disease associated with the accumulation in the brain tissue abnormal
proteins - amyloid-beta and tau protein.
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The main role in the neuronal damage in Alzheimer's disease is necessary, βamyloid Protein-Term, β-amyloid peptide. It has a neurotoxic effect. It is formed by
the cleavage of amyloid precursor. Excessive amyloid deposition occurs either by
excessive production or by catabolism of disorders due to extracellular amyloid
deposits.
The essence of the disease is Alzheimer's progressive atrophy of nerve cells in
the brain, leading to disruption of first functions and then to death. The death of nerve
cells is due to the formation of abnormal protein in the body (β -amyloid): its
synthesis is caused by genetic disorders that occur with age. Protein forms numerous
plaques (deposits) in the brain tissue, which cause the death of nerve cells.
HYGIENIC ASPECTS OF USING OF THE POLYMERIC MATERIALS IN
MEDICINE
Gubershtro Y., Pronin V., Sadykova A. – the 3-rd year students
Scientific leaders – Prof. Korshunova N.V., Kostina V.V.
The main advantage of polymers is their lightness, high specific strength and
the ability to impart a predetermined shape. This reduces the weight and volume of
structures.
Applicable polymers may produce odorous substances that create firm smell;
have a toxic, irritating and allergenic properties. Products made of polymers should
be safe.
In technology of medicinal forms these medicinal products are exposed to
special requirements: long-term preservation of physical and chemical properties
under the action of the enzyme properties of a living organism; biological inertness
(easy adaptation of the body to the contact).
Products made of polymer materials are intended for temporary stay in the
body and then they should disperse.
Polymers that come into contact with body tissues should not contain toxic
substances, and specific properties of the cumulative effect on the body. Upon contact
with body fluids they do not alter their physic-chemical properties. The polymers
should not produce substances which are not included in the formulation of the
material and don’t stimulate the growth of microorganisms.
CHARACTERISTICS OF DEATHS IN MECHANICAL ASPHIXIA
Gorshkova K. – the 5-th year student, Fedotova T. – the 6-th year student
Scientific leaders – Cand.Med.Sc. Cheryomkin M.I., Kostina V.V.
Asphyxia - a special form of hypoxia, combined with a high content of carbon dioxide
in the blood and tissues (hypercapnia).
According to data’s of many researchers in recent years the forensic medical
examination of persons who died of mechanical asphyxia is 25 - 30% of all violent deaths.
Hanging accounts 77%, drowning - 25%.
Among the dead the greatest part consists of the men; mainly age of victims ranged
from 31 up to 60 years old; mortality peaks occur in spring (31.6%) and summer (28.6%);
most of the corpses were found in the places (65.7%), mainly in flats (45.8%).
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The study showed that suicide is characteristic not only of very high incidence among
men of working age (25.94%) and that index is growing among both male and female
persons over 60 years old that is - 39.5% and 22 2%, respectively.
We must note that mostly people in active working age is killed. Therefore, the
problem of high mortality rate of asphyxia has long acquired a pronounced social character,
as it brings essential damage to productive forces of society.
HISTOLOGIC EVIDENCE OF MECHANICAL ASPHYXIA
Gigolyan A., Kucherenko T. – the 6th year students
Scientific leaders – Cand.Med.Sc., Assoc.Prof. Gigolyan M.O., Kostina V.V.
Histological studies method complements and deepens the macroscopic picture of a
typical specific characters (traces of mechanical action) and atypical (common asphyxial)
characteristics of various types of mechanical asphyxia. This type of research is of great
diagnostic value in dealing with issues related to determining of the presence, nature and
origin of damage in vivo. Microscopic examinations are confirmed or excluded by various
kinds of aspirations, tissue analysis is conducted for the presence of diatom plankton that
is used in the diagnosis of drowning.
In cases of asphyxia from compression of neck organs there is carried out a study of
the main features - strangulation furrow, but in this study, we must take into account the
macroscopic changes without which to give a full forensic assessment of the signs of
asphyxia is not possible.
Histological diagnosis of the aspiration of blood is based on the detection in the small
bronchi, bronchioles and alveoli the blood of the masses, and what is typical - the
formation of severe emphysema in the peripheral areas of the lung tissue, is regarded as a
compensatory phenomenon. In aspiration of food masses there is observed the presence of
the same parts of fragments of muscle fibers, fat, starch granules, fat droplets, and fiber.
VARIANTS OF CLINICAL COURSE OF ACUTE DISORDERS OF CEREBRAL
CIRCULATION
Eroputko S., Mirgyan, M. - the 4th year students
Scientific leader - Cand.Med.Sc., Assoc. Prof. A. I. Karnaukh A.I , Kostina V.V.
The clinical picture of disorders of cerebral circulation depends on the etiology,
localization and severity of stroke. According to international multicenter studies, the ratio
of ischemic and hemorrhagic stroke are in the average 5.0-5.5 : 1; i.e. 80-85 and 15-20%.
Hemorrhagic stroke includes bleeding into the substance of the brain due to rupture of the
vessel wall or hemorrhagic infarction of blood through the altered vascular wall. Ischemic
stroke is clinically manifested by focal neurological symptoms and constitutes a violation
of cerebral circulation, which is caused by significant reduction or sudden cessation of
blood supply to a certain area of the brain. To all patients with the aim of differential
diagnostics of hemorrhagic and ischemic stroke it was performed CT of the brain, duplex
scanning of the main arteries of the head.
Clinical manifestations of stroke maybe different and depend on the nature of
cerebrovascular disease and its localization and extent of the lesion. Part of the symptoms
may be due to the presence of chronic cerebrovascular insufficiency occurred in most
patients before the development of stroke, as indicated by the data of the additional survey.
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THE BIOLOGICAL ROLE OF SUCCINATES
Eroputko S., Mirgyan M. – the 4th year students
Scientific leaders – Cand.Med.Sc., Assoc. Prof. Anokhina R.A., Kostina V.V.
Succinic acid (succinates) is a substance produced during the processing of natural
amber. It is a completely product with a number of useful qualities. It is obtained in the
form of white crystalline powder, taste similar to citric acid. Succinic acid provides antivirus and anti-hypoxic action. Scientists have proved that succinic acid and succinates were
adaptogens. Succinic acid stimulates the process of oxygen to the cells, relieves stress,
restores energy, it normalizes the production of new cells, and has restorative and
regenerative properties. Restoring the balance of biochemical reactions in the body,
succinates normalize the function of all organs and tissues. Especially important is their
influence on the brain, therefore, succinic acid is used to prevent brain pathologies
developing in the aging process. It restores functions of the nervous system and prevents
stress. It has a favorable effect on the cardiovascular system, stimulates the liver and
kidneys, causing the body more effectively cleared of toxic metabolites and other harmful
agents. It enhances immunity due to more efficient synthesis of immune system cells. Due
to its antioxidant action, succinates inhibit the growth and development of tumors and
prevents division of cancer cells. Succinic acid is able to exert therapeutic effect even in
small quantities. It also increases the nutritional value of basic food components and
enhances the effect of medicines. These properties define it as a very useful dietary
Supplement that is restoring the work of all organs and systems of the body, the selfregulation of its functioning, accelerate recovery, and maintain the natural balance of this
life. Soccinic acid is available under several commercial names (Kogitum, Succinic acid,
Enteric, Mitomin, Enerlit, etc.) in four dosage forms – tablets, capsules, solutions for
injection and powder. Comprehensive pharmaceutical preparations containing as active
components not only succinic acid but also other substances, are as follows: Influnet,
Limontar, Remaxol, Serebrenik, Cytoflavin.
TELA AS COMMON CAUSE OF SUDDEN DEATH IN NEUROLOGICAL
PATIENTS
Mirgyan M., Eroputko S. – the 4-th year students
Scientific leaders - Prof. Sakharyuk A.P., Kostina V.V.
VTEC must be comprehensive and includes: ultrasound of the lower limbs with the
early stages of the disease and the dynamics of non-pharmacological means (compression
stockings, intermittent pneumatic compression of the lower extremities, early
rehabilitation, including the use of robotic techniques), medical prophylaxis (preventive
doses of LMWH in doses recommended by the manufacturers, prophylactic doses of
unfractionated heparin can be used at their inaccessibility. Starting the use of
anticoagulants should be at 2 days of the disease, provided a stable (including the
background of drugs) hemodynamic and availability monitoring.
MANIC-DEPRESSIVE SYNDROME
Mirgyan M., Eroputko S., Dadasheva S. - the 4th-year students
Scientific leaders - Brush N.G., Kostina V.V.
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Bipolar disorder manifests as depressive and manic phases. Alternation of
depression – intermission is a manic period of depression. Risk factors are premorbid
personality traits related to emotional instability, which is expressed in excessive affective
reactions to external causes, as well as spontaneous oscillations of mood. Pople who have
mental reactions differ by rigidity and monotony are susceptible to disease.
DISSEMINATED INTRAVASCULAR BLOOD COAGULATION
Baymysheva D. – 4th year student
Scientific leaders - Cand.Med.Sc. Kruglyakova L.V., Kostina V.V.
DIC (disseminated intravascular coagulation) - is: a secondary pathological process
that occurs at a constant and prolonged stimulation of the hemostatic system, having phase
current, with initial activation and subsequent deep progressive exhaustion of all parts of
the hemostatic system up to the total loss of the blood's ability to clot with development of
catastrophic uncontrolled bleeding and severe generalized hemorrhagic syndrome;
Triggering factors of DIC may be the wide variety of intense or prolonged stimuli,
somehow fit into a triad of Virchow - disorders of blood circulation, its characteristics or
vascular wall.
During DIC there are 4 stages:
Stage 1 - Phase of hypercoagulation and hyperaggresion of platelets;
Step 2 - a transitory phase (multidirectional changes in blood clotting both in the direction
of hyper- and towards hyporcoagulation);
Stage 3 - phase deep anticoagulation (blood does not clot at all);
Stage 4 - the resolution phase (or normalized hemostasis, or develop complications that
lead to death).
In the first phase there is increased clotting instant clots in large vessels and small
clots (during operation). The patient is not possible to take a blood test, since it is
immediately minimized. As a rule, the first phase is very fast and unnoticed by doctors.
There is a sharp decrease in blood pressure, skin pale, covered with cold sticky sweat, weak
pulse (thready). Then, there develops respiratory failure due to lung disease, cough and
crackles in the lungs, skin cyanosis, cold feet and hands. In the second phase there is
retained the same symptoms as in the first stage of DIC, plus the process involved kidney
(renal failure), the adrenal glands, digestive tract (nausea, vomiting, abdominal pain,
diarrhea).
The third phase (anticoagulation stage) is characterized by massive bleeding, like
from the original hearth and of other organs (stomach and intestinal bleeding due to
ulceration of the mucous, blood in urine - kidney disease, sputum mixed with blood when
expectoration). It is also characterized by the development of hemorrhagic syndrome
(occurrence of massive bleeding, bruising, petechiae, uncontrolled bleeding at injection
site and during the operation, bleeding gums, nosebleeds, etc.). The fourth phase with
timely and appropriate treatment leads to restoring of hemostasis and stopping of the
bleeding, but it often ends by lethal in massive defeat of internal organs and bleeding.
Treatment of the underlying disease - the main thing that is required to do in the fight
against intravascular coagulation.
QUANTITATIVE DISTURBANCES OF CONSCIOUSNESS
Baymysheva D. – 4th year student
Scientific leaders - Cand.Med.Sc., Assoc.Prof. Karnaukh A.I., Kostina V.V.
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For the doctor of any specialty in any medical establishment it is important to
determine the degree of impairment of consciousness. Quantitative disturbances of
consciousness is associated with the activation of violations, which leads to a decrease in
the level of consciousness with a kind of "off," the oppression of mental activity (mainly
due to the suffering sredinnostvolovyh structures).
There are: 1. a clear consciousness; 2.oglushenie moderate; 3. stunning deep; 4.
sopor; 5. coma moderate; 6. deep coma; 7. coma terminal (prohibitive).
A clear mind: the safety of all mental functions: the ability to correct perception and
understanding of the world and of their own "I". Adequate steps critic maintained, full
voice contact, reaction to stimuli - adequate and targeted, and allopsychic, autopsychic
orientation are preserved.
Stun is mild: mild drowsiness, reduced active attention, rapid exhaustion, voice
contact - saved, but sometimes you want to repeat the questions, answers are slowed,
monosyllabic. Sophisticated commands are performed slowly. On appeal to him the eyes
are opened immediately. The motor response to pain - the active, purposeful. Allopsychic
orientation - is inaccurate. Autopsychic orientation - is preserved. Monitoring for the
function of the pelvic organs is kepx.
Stunning deep: deep lethargy, the patient almost always in a state of sleep, active
attention is reduced, fast exhaustion, voice contact is limited, need to repeat the questions,
answers slowed, monosyllabic. It performs only simple commands. On appeal to him the
eyes are opened immediately. The motor response to pain - is preserved. The response to
other stimuli is changed. Allopsychic orientation is partly preserved. Autopsychic
orientation is partly preserved. Monitoring of the function of the pelvic organs is weakened.
Sopor: deep depression of consciousness, lack of mental activity with the
preservation of a coordinated security responses to pain and other stimuli.
Coma: shutdown of consciousness with complete loss of perception of the world
itself, the absence of other signs of mental activity, the gradual suppression of reflex
reactions and functions of vital organs. Depending on the severity and duration of the
violations coma severity is divided into three levels: mild (in response to pain stimuli
uncoordinated defense reactions); deep (the absence of any reaction to external stimuli);
terminal or prohibitive (total areflexia).
To determine the degree of depression of consciousness using the Glasgow Coma
Scale:
15 points - a clear conscience;
14-13 points - moderate stunning;
12-10 points - a deep torpor;
9-8 points - the stupor;
7 points or less - coma.
THEORY OF PATHOGENESIS OF ALCOHOLISM BY ANOKHIN I.P.
Baymysheva D. – 4th year student
Scientific leaders - Brush N.G., Kostina V.V.
Alcoholism is a problem, which reflects typical psychiatric difficulties in
understanding the causes and mechanisms of disease. A series of investigations conducted
by Anokhin I.P. with colleges over the past 10 years, has allowed to formulate a theory
about the leading role of catecholamines in the development of alcoholism. Acting on the
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catecholamine neurotransmitter system of the brain, alcohol leads to increased release of
norepinephrine and dopamine from presynaptic structures in the hypothalamus and
midbrain. This may explain the agitation in the first phase of intoxication in humans, that
these structures are activating system of the brain. However, alcohol and further contributes
to the enhanced destruction of neurotransmitters catecholamine nature, which entails a
reduction in the concentration of norepinephrine, a decrease in the activity of the
corresponding brain structures. Clinically, it may correspond to the second phase of
intoxication, proceeding with a depressive component, depression and lethargy.
At long-term use of forced alcohol debilitating CNS neurotransmitters emissions
combined with their power of destruction, cause a deficit of norepinephrine and dopamine
brain. The result can be a reduction in the patient's mood and performance against this
background, and receive a relatively moderate amounts of alcohol, which stimulates the
release of catecholamines, causing a short time condition improved, creased tone. Again,
there is an increasingly growing shortage of these neurotransmitters in the brain. In turn,
this state is pushing patients on a regular intake of alcohol, in order to somehow improve
their time on the condition and state of health. Thus, a vicious circle «circulus vitiosus» a classic example of a pathological chain of transformations. Pathological essence of the
vicious cycle that breaks down the functioning of the mechanism of feedback in the system.
Such closed on dead-end functional components can be found at various levels of the
organism in alcoholism. A vicious circle, named above, and the main leads in the end to
the progression of the disease, as exhausted compensatory capacity of the organism.
Compensatory role is performed observing in alcoholism increased synthesis of
catecholamines in the central nervous system.
There is an accelerated circulation of catecholamines, and this is a major shift, indicating
the biological changes in the body, about the formation of alcohol dependence and craving
for it. Emissions may be terminated, the collapse of catecholamines can return to normal,
and the synthesis is steill be reinforced. Upon termination of habitual alcohol intake. In this
activity an essential enzyme is reduced.
There is a clear correlation between the degree of concentration of dopamine in the
blood and the severity of the clinical condition of patients with alcoholism.
FOLATE CYCLE VIOLATION DURING PREGNANCY
Eroputko S., Mirgyan M. – the 4th-year students
Scientific leaders - Cand.Med.Sc. Zaritskaya E.N., Kostina V.V.
In the first 12 weeks folic acid is responsible for the correct formation of the fetus
neural tube. Folic acid deficiency causes congenital malformations of the fetus and the
sulfur amino acid metabolism is disturbed and there is a delay amino acid homocysteine in
the blood. Due to the decreased activity of the folate cycle enzymes, which are responsible
for the conversion of folic acid (MTHFR, MTRR, MTR) there is an accumulation of
homocysteine in the body that can stimulate the formation of blood clots. This leads to
abortion, premature placental abruption, preeclampsia and chronic fetal hypoxia. It is
necessary to add on the earlier timing of folic acid in the diet, it helps reduce the risk of
complications during pregnancy, especially it is necessary in the presence of
hyperhomocysteinemia.
THE CAUSES AND PATHOGENESIS OF PSORIASIS
Trubachyov R., Smirnova A., Blagova Zh. - 3rd year students
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Scientific leaders – Cand.Med.Sc. Levchenko N.R., Kostina V.V.
Psoriasis is a chronic dermatosis characterized by scaly papular rash on the skin.
The most common are viral, hereditary (genetic), neurogenic and metabolism (metabolic)
disease theory, but none of them is universally accepted. There are parakeratosis,
acanthosis in intrapapillary areas of malpighian layer and thinning of its papillary sites,
intracellular edema and spongiosis, accumulation in the intercellular spaces, penetrating
the dermis of neutrophils (microabscesses Munro). In the old elements hyperkeratosis is
more pronounced than parakeratosis; nuclei in the stratum corneum occur independently
of the antiguite of papules. The granular layer disappears or persists interrupted a number
of its cells. In acute cases of missing and shiny coat. Malpighi layer above papillae is
thinned, epidermal outgrowths are elongated. The styloid layer between the papillae
pronounced acanthosis. The capillaries of the papillary layer are expanded strongly
crimped, overflowing with blood.
ARE THERE EXTRA ORGANS IN THE ORGANISM?
Rytenkova A., Kazmina A. – the 1-st year students
Scientific leaders – Zherepa L. G., Kostina V. V.
A biologist Ilya Mechnikov supposed that there were too much «superfluous»
intestines in the organism of man, and the French doctor Franz Glenar asserted in
general, that some organs were located quite wrong at us.The whole segments of
large intestines were cruelly thrown out, a coccyx was retired, and although after
such interference the patients felt themselves from bad to worse.
An appendix, quite not is a rudimentary. Appendix – important part of the
immune system of man, participating in a homoeostasis: it helps to support balance
in process of all organs and tissues. A spleen carries out immune control of blood.
Amygdales (tonsils) are appeared as our first defender at intruding of microbes to
the organism. Also protective proteins– interferon, immunoprotein are produced in
tonsils. Thymus (thymus gland) - one of main organs responsible for immunity.
Truncal cells, getting into thymus, are transformed into T-lymphocytes,
including «cells killers», that destroy viruses and bacteria.
Attempts to perfect the devices of human organism do not cease in our days. It is
assisted by successes of the genic engineering. As some gerontologists consider the
reconstructed man will be able to live 200 years.
Presently scientists came to the conclusion, that in a human organism nothing
superfluous can be. Many organs are rehabilitated, but yet their greater number is
studied not enough, and their functional destiny is not found out.
THE SEX AND AGE CHARACTERISTICS OF THE SKULL
Nazarenko D. – the 1-st year student
Scientific leaders – Zherepa L. G., Kostina V. V.
Skull from the moment of birth of the child is undergoing major changes until the end
of life. They come under the influence of reconstruction of bone architecture. The changes
in the skull can be divided into five age periods.
The first period covers the years from birth up to 7 years old. Active growth is
characteristic of its skull.
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The second period of the skull changes occur between 8 and 13-14 years old and is
characterized by a relative slowdown in the growth of the skull bones, although there was
a significant increase in the nasal cavity, the upper jaw and eye socket.
The third period lasts from the beginning of puberty (14-16 years old) up to 20-25
years old, the end of skeletal growth.
The fourth period (26-45 years old) are most stable when changing of the size of the
skull does not occur.
The fifth period lasts from the time of the imperforate seams 45 years to old. It is
characteristic for it marked transformation of the facial skull, associated with tooth loss.
Male and female skulls have significant anatomical features noted in 80% of cases.
STATINS
Guschin D., Moskvitin D. - 4-th year students
Scientific leaders - Assoc. Prof., Cand. Med. Sc. Tikhanov V.I., Kostina V.V.
Statins, also known as HMG-CoA reductase inhibitors, are a class of lipidlowering medications. They inhibit the enzyme HMG-CoA reductase which plays a central
role in the production of cholesterol. There are several generations of statins, among which
are drugs such as fluvastatin, atorvastatin, and rosuvastatin. Now in clinical practice statins
of the last generation are used, containing atorvastatin, cerivastatin, rosuvastatin and
pitavastatin. Statins are used to reduce cardiovascular disease, for prevention of
atherosclerosis and successfully using in the rehabilitation of myocardial infarction. Also,
statins help to reduce cell adhesion, potentiate the anti-inflammatory effects and stabilize
the shape of an atherosclerotic plaque.
VIOLATIONS OF VASCULAR PERMEABILITY. DAMAGE TO THE
VASCULAR WALL
Beznutrov Ya. –the 2nd year student
Scientific leaders - Dr. Sci. Biol. Batalova T. A., Kostina V.V.
Violations of vascular permeability (transcapillary exchange) are due to the very
vascular pathology (mainly the endothelium and basement membrane of capillaries and
venules), impaired ability to pass water, and it contains a substance through ultrafiltration
processes, diffusion, pinocytosis, active intracellular carriers like without energy costs and
with the expenditure.
In pathological conditions, violation of vascular permeability often characterized by
its increase. Increased traffic exchange may be related to structural changes in the walls of
microvascular and speakers with impaired circulation.
The reasons for increasing the permeability of microvessels (transcapillary
exchange) are most often the inflammatory processes in tissues, allergic reactions, shock,
tissue hypoxia, burns, cardiac failure, thrombosis, and compression of the veins,
hypoproteinemia, transfusion of protein and salt solutions.
As a result of micro traumas of the vessel walls is the development of acidosis and
activation of hydrolases, swelling (edema) of endothelial cells, the appearance and increase
the roughness of their shells, hyperextension of the walls of microvessels (which leads to
stretching fenestrae formation and micro-breaks in the walls of microvessels).
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ACUTE NECROTIZING FASCIITIS
Baldanov E. – the 3-rd year student
Scientific leaders - Cand.Med.Sc. Bubinets O.V., Kostina V.V.
Acute streptococcal necrotizing fasciitis is caused by S. pyogenes, which is a betahaemolytic streptococcus of group A. This pathogen produces hemolysin, streptolysin O
and S leukocidin. These properties determine the pathogen and the pathogenesis of typical
clinical picture.
β-hemolytic streptococcus group A (pyogenic streptococci, BGSA S.pyogenes) Gram-positive Non-spore, fixed microorganism. It occurs everywhere, often colonizes the
skin and mucous membranes of man. Transmission routes are airborne, contact and food.
The input gates of infections are damage of the skin and deeply lying tissues. During
the multiplication of streptococcus in the dermis their toxic products enter the bloodstream.
Toxemia causes infectious-toxic syndrome with high fever, chills and other symptoms of
intoxication. Factors of pathogenic streptococci, which have cytopathic effect: cell wall
antigens, toxins and enzymes play an important role in its development.
The frequency of the NF is 0.4 per 100,000 of population. Mortality due Mc Henry
statistics is 33%.
Treatment of necrotizing fasciitis is to maintain vital functions, excision of necrotic
tissue, and parenteral administration of antibacterial agents.
THE STRUCTURE OF THE MUCOS OF THE RESPIRATORY ORGANS WITH
PNEUMONIA
Mamontov S. – the 2nd year student.
Scientific leaders - Dr. Med. Sc., Prof. Krasavina N. P., Kostina V. V.
The lungs are the organs of external respiration in men. They consist of an airway
system – the tracheobronchial three and acini, in its structure there are the alveoli
with surrounding blood vessels and nerves. The bronchial tree lung is made up of the
bronchi system: the main, lobar, regional, segmental, small and terminal.
The wall of the large bronchi is presented by 4 shells: mucosa, submucosa, fibrouscartilage and adventitia.
The mucosa is lined with multi-row ciliated epithelium. 7 types of cells are
identified in the epithelium: ciliated goblet cells intercalary, brush cells, bronchiolar
exocrine cells and dendritic.
Lungs are fitted with safety systems. These systems include air conditioning, nasal
and tracheobronchial, mucociliary, alveolar clearances and immune mechanisms.
One of the diseases of the respiratory system is bronchopneumonia. It is an
inflammation of the lungs that develops due to bronchitis.
Bronchopneumonia has morphological features depending on the type of
infectious agent causing it. The greatest manifestation has staphylococcal,
streptococcal, pneumococcal, viral and fungal focal pneumonia.
CACHEXIA
Serebrennikova A – the 2nd year student
Scientific leaders – Assoc.Prof.,Cand.Biol.Sc. Doroshenko G. K., Kostina V. V.
Cachexia – extreme attritions of all organism, with change of physiological
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process and disturbance of a mental condition of the person. Types of cachexia: 1.
primary; 2. secondary; 3. a cachexia on the basis of starvation and malnutrition.
Cachexia reasons: 1. alimentary system; 2. amyloidosis; 3. endocrine diseases; 4.
gerontal cachexia;
Nutrients perform function of protection of system`s organs, redistributing energy
and plastic resources, their adaptation passes through hormones. At starvation or
malnutrition of products, adaptation is made through depressions of insulin and rising
of catabolic, somatotropic hormones. At incontinuous starvation, the person still has
resources to ensure normal functioning of organs of system, but at the end of one and a
half weeks resources come to an end that leads to disturbance of functions of an
organism.
For recovery of healthy nutrition of the patient with all necessary components and
vitamins it is especially important that the nutrition has to be easily acquired and contain
necessary amount of proteins and fats.
MAGNETIC RESONANCE ANGIOGRAPHY
Lopatina E., Ondar S. – the 6th year students
Scientific leaders - Dr.Med.Sc., Prof. Yanovoy V.V., Kostina V.V.
Magnetic resonance angiography - a highly informative and safe method of beam
diagnostics, allowing to evaluate the anatomical and functional characteristics of blood
vessels.
Currently, the method can successfully diagnose arterial aneurysms, arteriovenous
malformations of the brain and spinal cord stenosis and thrombosis of vessels, their
developmental abnormalities, inflammation of the vascular wall (vasculitis),
atherosclerosis of the arteries. In the case of tumoral lesions, this method provides more
information about the deployment of the main tumor vessels, and in some cases allows you
to visualize the tumor vasculature.
There are two main methods of performing magnetic resonance angiography without contrast enhancement, and contrast-enhanced MRA. No contrast is usually
examined brain vessels and arteries of the neck, with the contrast - the aorta, renal arteries,
the arteries of the lower extremities.
The method of magnetic resonance angiography is based on the difference of
signal of the moving tissue (blood) from the surrounding stationary tissue. Under the
influence of a strong magnetic field, the spins of the nuclei of hydrogen protons change
their position and are arranged along the magnetic field axis.
Advantages of the method: get a clear and detailed images of blood vessels without
the need for catheterization and therefore no risk of artery damage and related
complications; time spent on the research process and the rehabilitation period is shorter
than that required for contrast angiography; lower cost compared with contrast
angiography; there is no need of the patient X-ray exposure; no need for radiopaque
formulations for which the patient can be observed allergy.
Absolute contraindications for the method is the presence of a pacemaker or other
implanted metallic devices in the patient's body. Claustrophobia, pregnancy, mental
disorders with the impossibility of long-term presence in the supine position at rest are
included into relative contraindications.
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HISTOPHYSIOLOGY OF LUNGS IN NORMAL AND IN PATHOLOGICAL
CONDITIONS
Grek N. - the 2nd year student
Scientific leaders – Kozlova V.S., Kostina V.V.
Lungs are paired parenchymatous organs. The lung is covered by serous membrane –
visceral pleura. In the lungs the part of the Airways (tracheo-bronchial tree), and respiratory
division are contain. Lung consists of particles, segments, lobules and acini. The bronchial
tree includes: 1)main bronchi; 2)bronchi 1 to 15 of the order;3) the terminal bronchioles.
After terminal respiratory bronchioles begin the divisions, the structural- functional unitsacini. It is a system of air cell, alveolar passages and alveolar sacs. Acinus begins by
brorchioles of 1st, 2nd and 3rd order. The composition of the epithelial lining of the alveoli
there are the 3 types of cells: alveoli of the 1st type(respiratory); alveoli of 2nd type secrete
a surfactant ; alveoli of 3rd class control the concentration and composition of surfactant.
Lung pathology is congenital or acquired. The congenital includes malformation of the
lung; abnormalities of the lung vessels. Injuries, tumors, pneumoconiosis, bronchial
asthma, tuberculosis are acquired pathology.
SARCOIDOSIS
Fomina E.-the 3-rd year student
Scientific leaders - Cand.Med.Sc. Levchenko N.R., Kostina V.V.
Sarcoidosis (Besnier-Boeck-Schaumann disease) - a systemic disease of unknown
etiology, which is based on histopathology epithelioid cell granulomatous structure without
evidence of caseous necrosis. Sarcoidosis occurs worldwide and affects people of all ages
and races. Its prevalence varies depending on geographic location and racial groups.
Cardiac involvement is typical for Japanese, lupus pernio for Afro-Americans and nodosal
erythema for Europeans (3-5 per 100 thousand.).
The pathogenesis of sarcoidosis.
Lymphocytic alveolitis. This is the earliest change in the lungs, caused most likely by
alveolar macrophages and T-helpers that release cytokines. At least part of pulmonary
sarcoidosis patients have oligoclonal local expansion of T-lymphocytes, causing by an
antigen-driven immune response.
Sarcoid granulomas. The formation of the granuloma controls the cascade of cytokines.
Granulomas can form in various organs. They contain a large number of T-lymphocytes.
At the same time, sarcoidosis patients are characterized by reduced increase of cell and
humoral immunity: blood levelsof T-lymphocytes arereducedand number of Blymphocytes - normal or elevated.
Anergy to skin tests. That substitution of lymphoid granuloma tissue leads to
lymphopenia and anergy to the skin test antigen. Anergy often does not disappear even
when clinical improvement and is probably due to the migration of circulating
immunoreactive cells in the affected
PORPHYRIA
Gusevskaya V., Verhoturov D., Paputsya I.- the 2-nd year students
Scientific leaders – Cand Med.Sc. Egorshina E.V., Kostina V.V.
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Porphyria or porphyrin disease - almost always an inherited disorder of pigment
metabolism with a high content of porphyrins in the blood and tissues.It is manifested by
photodermatosis, hemolytic crises, gastrointestinal and neuropsychological
disorders.Severe cases of this disease led to the legend of the vampire. The most common
species is its acute intermittent porphyria (EPP).What is the mechanism of the disease?
Non-protein part of hemoglobin - heme - turns into a toxic substance that corrodes the
subcutaneous tissue. The skin starts to get brown color, becoming thinner and by exposure
to sunlight it bursts, so the skin of patients is covered with scars and sores. Ulcers and
inflammations damage the cartilages - the nose and ears, deforming them.Together with
covered with sores, eyelids and twisted her fingers, it's incredibly disfigures man. Sunlight
contraindicated for patients, which brings them untold suffering.
MALE GENITAL GLANDS
Voynitskiy A. – the 2 nd year student
Scientific leaders - Cand. Med. Sc. Semyonov D. A., Kostina V. V.
The indifferent gonad begins to develop on male pattern from the 7 th week of
embryogenesis, when there is formation of seminiferous tubules tab under the influence of
the expression of factors Y - chromosome. Male genital glaudsare laid on the surface of
the primary kidney. As the egg migrates back down the abdominal wall it, is covered by
the peritoneum. Connective partitions divide the gland into segments whose number
reaches 250. In each lobe there is from 1up to 4 of the convoluted seminiferous tubules.
Each seminal tubule has a diameter of 150 up to 250 microns and a length of 30 up to 70
cm. In the eggs lobes spaces between the convoluted seminiferous tubules are filled with
layers of loose connective tissue, which has in its composition a special endocrine cells of
Leydig-cells which secrete the hormone testosterone regulating spermatogenesis and
manifestation of secondary sexual characteristics. Testosterone is the most active
androgenic hormone. Outwards from epiteliospermatogenny layer of seminiferous tubule
there is its own membrane, consisting of three layers: basal, mioidny and fiber.
Epiteliospermatogenetic has two major populations of cells, spermatogenic cells at
different stages of differentiation, and supporting cells, and Sertoli cells. Between
neighboring supporting cells it is formed tight junctions zone that divided spermatogenic
epithelium into two sections - the outer and the inner basal adlyuminalny.
Supportingepitheliocytes create epithelial microenvironment needed for differentiating
genital,isolate forming germ cells from toxic substances and various antigens, prevent the
development of immune responses. Thus, the Sertoli cells are important competent of
hemo-testicular barrier.
KIDNEY AND ITS DEFECTS
Verkhoturov D. - the 2 – nd year student
Scientific leaders - Cand. Med. Sc. Semyonov D.A, Kostina . V.V.
Kidney - paired organ in which urine is produced continuously. The basic function
of kidneys-removal from the organism the foreign substances, metabolic products, excess
water and ions. It is carried out through formation and evacuation of urine. Kidney is
covered with a connective tissue capsule, the front of the serous membrane. Substance of
kidney cortex is divided into a dark red medulla lighter color. Kidney filter consists of three
layers: the endothelium of the capillary, basal membrane capsule of Bowman, specialized
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epithelial cells, podocytes. Structural and functional unit kidney is the nephron, the total
number of it is more than 2 million. Kidney passes stages of development: the front kidney,
kidney and primary constant. During the period of uterine development there occur some
defects: bilateral renal agenesis occurs at a frequency of 0.1-0.3 per 1000 of in fats and
often in boys. This malformation may be an isolated pathology, but sometimes are part of
the syndrome, which occurs due to chromosomal abnormalities. A child with this birth
defect often die within a few days after birth. Polycystosis of kidneys disease (fine-cystic
kidney disease) -autosomno recessive inheritance violations with bilateral symmetrical
increase in kidney. At the base of the anomaly is the primary defect of collecting tubes
which have lost their ability to properly connect with the distal tubules forming
metanephric nephron. Like horse shoe kidney arises from the fusion of two embryonic
metanephric rudiments, the lower pole of which merge at the level of lumbar vertebral
bodies to form one large body. The cause of this malformation is an obstacle movement of
kidneys in the cranial direction, created a by trunk of the inferior mesenteric artery. A
kidney grows and changes all human life, in the process of it there can also develop
abnormalities.
HISTOPHYSIOLOGY OF SMALL INTESTINE AND ABSORPTION
PROCESSES
Papytsya I. - the 2- nd year student
Scientific leaders - Cand.Med.Sc. Semyonov D.A.,Kostina V.V.
Small intestine- division of the human digestive tract, located between the stomach
and large intestine. In the small intestine section chyme is treated by saliva and gastric
juice and intestinal juice, and is exposed to action of bile, pancreatic juice, later digestion
products are absorbed into the blood and lymph capillaries.
The wall of the small intestine is constructed mucosa from submucosa and muscle
serous membranes. The inner surface of the small intestine has a characteristic relief due
to the presence of a number of formations- circular folds, villi and crypts. These structures
increase the overall surface of the small intestine, thereby fulfilling its main digestive
functions. Intestinal villi and crypts are the basis structural and functional units of the
small intestinal mucosa. Intestinal villi are finger-mucosal protrusions or leaf-shaped,
freely jutting into the lumen of the small intestine. Absorption in the small intestine: the
presence of folds provides greater villi suction surfase. Absorption of electrolytes: one of
the most important functions-transport of sodium ions. The small intestine is involved in
all stages of digestion, absorption including a stirred chyme.
FIBER-OPTIC BRONCHOSCOPY WITH DUST BRONCHITIS
Belunkina E., Prilutskaya A. – the 4th year students
Scientific leaders - Cand. Med. Sc. Goryacheva S. A., Kostina V.V.
Dust bronchitis is a disease of the bronchial tubes when diffuse loss is not due to
infection, but due to mechanical or chemical action on the mucous membranes of the
bronchial tree of dust particles, which are in the inspired air. This disease belongs to the
category of professional and is chronic. Endoscopic examination of the bronchi allows to
estimate visually the condition of the bronchial tree and, if necessary, to carry out
histological studies. In chronic dust bronchitis with endoscopy it is often revealed atrophic
changes in the mucosa, atrophy of the bronchial glands, and also can be detected the
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deformation of various parts of the bronchial tree. Kind of the mucous membrane of the
trachea and bronchi is: pale, thinned, with sharply wibehouse cartilaginous rings into the
lumen of bronchi and "valleys" of interchondral spaces. Areas of dust pigmentation of the
mucous membrane - "tattoo" at all levels of the bronchial tree. The excretory ducts of the
bronchial glands are enlarged and gaped, arranged in groups, clearly visible in the region
of spurs and subsegmentary segmental bronchi, reminding bronchopneumania fistula. At
hypersecretion there may be redness and swelling of a diffuse nature. The excretory ducts
of the bronchial glands is more pronounced. The appearance and quality of secretions:
mucous lumps, on the walls of the bronchi there are puriform movable lumps. Sometimes
there is vitreous mucus, it is often of frothy character. The form and character of folding
of the mucosa: folding is moderately strengthened.
HYPERKINETIC SYNDROME
Varaksina A., Melnichenko A. - the 4-th year students
Scientific leaders - Bugrova M.I., Kostina V.V.
Hyperkinetic syndrome - a disorder characterized by disturbance of attention, motor
hyperactivity and impulsive behavior. Hyperkinetic disorder can begin at a very early
age. For the diagnosis of hyperkinetic disorder the state must correspond to the
following criteria: 1) Violations of attention; 2) hyperactivity ; 3)impulsiveness ; 4)start
of the disorder at the age of 7 year old.
STEM CELLS IN BIOLOGY AND MEDICINE
Nesterenko T. – the 2nd year student
Scientific leaders – Cand. Med. Sc. Semyonov D. A., Kostina V. V.
Stem cells - undifferentiated cells are found in all multicellular organisms. These cells
do not yet have their specialties, such mechanisms are not yet included specialization is
why such stem cells and allow them to use any regeneration of organs and tissues. Stem
cells have the ability to self-renew, the formation of new stem cells, as well as to
differentiate into specialized cells. Stem cells are divided into embryonic and adult cells.
Embryonic cells can proliferate faster and more frequently than mature, fully differentiated
cell. This means that the donor cells are able to quickly restore lost function of the body.
Additionally, these embryonic stem cells can differentiate in response to the signals of their
environment. Due to their location, they can grow, elongate, migrate and establish
functional connections with other cells in the body around them. In these cells, the
mechanisms that determine the specialization is not yet included, so one can develop any
cells. Adult cells, in particular hematopoietic stem cells are able to multiply and
differentiate divided into distinct populations of mature erythroid cells. Hematopoietic
stem cells maintain a pool of blood cells by self-renewal and production of daughter cells
which differentiate into lymphoid, myeloid and erythroid line. Bone marrow
transplantation can restore hematopoiesis, and the title role in the play hematopoietic
(hematopoietic) stem cells that make up a significant proportion of bone marrow cells.
Stem cells have occupied a special place in medicine and the use of technology are
developing rapidly.
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ZIK`S VIRUS
Rogovchenko A. - the 3-rd year student
Scientific leaders - Cand. Med. Sc Prokopenko A.V., Kostina V.V.
Zik`s virus is a flavivirus, carried by by mosquitoes. It was discovered in 1947 in
the Zik`s forest (Uganda) among macaques. Symptoms of the disease are similar to
symptoms of other arbovirus infections, such as dengue fever: it is a fever, skin rash,
conjunctivitis, pain in muscles and joints, malaise, and headache. These symptoms are
usually mild and persist for 2-7 days. It is assumed that the virus initially infects dendritic
cells near the place of introduction and then spread to the lymph nodes and blood flow.
The virus has a strong neurotropism and infects efficiently neuronal progenitor cells. As a
result of a comprehensive analysis of the actual data ,the scientific community has come
to a consensus that Zik`s virus causes microcephaly and Guillain-Barre syndrome. Zik`s
virus is transmitted to human beings in tropical regions through the bites of infected
mosquitoes of the genus Aedes, mainly species Aedes aegypti. Typically Aedes mosquitos
bite in the daytime, their activity peak is in the early morning, late afternoon and evening .
Sexual transmission of Zik`s virus is also possible. As of June 2016 there aren`t vaccines
and drugs for prevention and specific treatment of Zik`s fever. Clinical trials are conducted
on the basis of DNA.
FOOD POISONING OF MICROBIALL ORIGIN
Rogovchenko A. - the 3-rd year student
Scientific leaders - Prof. Korshunova N.V., Kostina V.V.
Food poisoning is an acute disease resulting from eating food containing
microorganisms and toxic substances of microbial and amicrobic nature. Food poisoning
of microbial origin can be divided into three groups: infections, toxicosis and mixt.
Measures for prevention of microbial food poisoning include: 1.Sanitation of infection
sources 2.Prevention of ingress of pathogens and their toxins into foods: A) observance of
conditions, time of keeping, transportation and implementation of perishable foods and
ready meals in accordance with the sanitary rules and regulations; B) periodic disinfection,
disinfestation ( destruction of insects) and rodent extermination in caterings. C) personal
hygiene 3.Prevention of accumulation of pathogens and their toxins in food. 4.Destruction
of pathogens and toxins in food. It is necessary to pick up such conditions in which
microbes will die and their quantity REDUCES. 5.Hygienic training of personal in public
caterings.
Following these conditions, you will save yourself and your family from possible troubles
and diseases. Be healthy!
ENDOSCOPIC HERNIOPLASTICA
Rogovchenko A. – the 3-rd year student
Scientific leaders - Cand. Med. Sc., Assoc. Prof. Sergienko A.V. , Kostina V.V.
Endoscopic hernioplasty is operation performed inside abdomen through small
incisions 2-3 cm in size with special video devices and manipulators. The operation is
performed under general anesthesia. Traumatism in this type of surgery is minimal, the
recovery period is short and there is a good cosmetic effect.
Advantages of endoscopic hernioplasty:
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-Reticulate implant covers all weak spots in the anterior abdominal wall, respectively
appearance of relapses is practically unlikely.
- The absence of large scars on the skin
-Short recovery period, it does not require admission to hospital for more than 1 day.
- Most people can begin to work the next day.
IMMUNE RESPONSE OF NEWBORNS WITH CEREBRAL ISCHEMIA
Yakubovskaya T. – the 3-rd year student
Scientific leaders - Cand. Med. Sc. Gorikov I. N., Dr. Med. Sc. Batalova T.A., Kostina
V.V.
The aim of this work was to study the immune response in 25 full-term newborns
with cerebral ischemia of moderate-and-severe degree in utero mixed respiratory viral
infections. It is established that in cerebral ischemia of moderate-to-severe degree in
newborns with intrauterine mixed respiratory virus infection as compared with healthy
newborns, in cord blood serum there is determined a fourfold increase in titers of antibodies
to influenza virus In (12), A(H3N2) (7) and parainfluenza type 3 (6) in comparison with
those of their mothers. In the development of intrauterine infection by several pathogens
in newborns with cerebral ischemia of moderate-to-severe whose mothers suffered mixed
respiratory viral infection during the second trimester of pregnancy, an important role is
played by the violation of the utero-placental-fetus blood flow, endotoxemia, structural
changes in the placenta (angiopathy, inflammation), antenatal hypoxia, which increases the
permeability gematoplacental barrier to viral antigens, leading to an increase of
concentration of immunoglobulin M and to a fall of the content of immunoglobulin G,
midmolecular peptides and seromucoid in the blood from the vein of the umbilical cord.
PORTAL HYPERTENSION
Umarova S., Omoniddinova U. – the 3rd year students
Scientific leaders – Cand.Med.Sc., Assoc. Prof. Sergienko A.V., Kostina V.V.
Portal hypertension - high blood pressure syndrome in portal vein is caused by a
violation of blood flow in the vessels of portal, hepatic vein and inferior vena cava.
Normally, the pressure in the portal vein system is 5-10 mmHg. Increased pressure in
the portal vein system, above 12 mm Hg shows the development of portal hypertension.
Varicose veins occur when the pressure in the portal system is more than 12 mm Hg.
In most cases, portal hypertension is a consequence of liver cirrhosis, schistosomiasis
(in endemic areas), structural abnormalities of hepatic vessels.
If the pressure in portal hypertension in small hepatic vein is higher or equal to 12 mm
Hg., collateral circulation occurs between the portal venous system and the system
network. A portion of the portal blood along collaterals (varices) taking aside flow from
the liver which helps to reduce portal hypertension, but never completely eliminate it.
Collaterals occur in places of proximity branches of portal and systemic venous network:
in the lining of the esophagus, stomach, rectum; on the anterior abdominal wall (between
the umbilical and epigastric veins).
The diagnosis of portal hypertension is established on the basis of clinical evaluation
data, imaging methods and endoscopy examination. Portal hypertension, the symptoms of
which are based on the manifestations characteristic for dyspepsia, ascites, splenomegaly,
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varicose veins of the esophagus and stomach and intestinal bleeding, as a radical method
of treatment there is the need for surgical intervention.
LOCAL TREATMENT OF WOUNDS AND WOUND INFECTION
Umarova S., Omoniddinova U. - the 3rd year students
Scientific leaders – Dr.Med.Sc., prof. Chubenko G.I., Kostina V.V.
Local are treatment of wounds and wound infection is still the field of surgery, in
which there no clear standards. A huge number of local antimicrobial agents found its niche
as a result of adequate information deficit among practitioners, the influence of
pharmaceutical companies and outdated ideas that can lead to the wrong treatment of
patients.
As a result, anonymous survey of Russian surgeons conducted by V.V. Privolnev
(2016), there was produced "census" of local products, which are used in surgical practice
for treatment of wounds and wound infections (46 local agents).
Following the results of the survey it was found that doctors overestimated the value
of the ointment "Levomekol" in the first phase of wound healing process, the drug can not
be considered a universal remedy in this phase. In the first phase of wound healing process
there should be greater use of combined ointment on the basis of bacitracin, neomycin,
ofloxacin, povidone-iodine and silver products.
Second in the phase of wound healing ointment is applied with the effect of
stimulating regeneration. In this period it is necessary to limit the use of antiseptics,
especially drugs based on potassium iodide and hydrogen peroxide due to cytotoxicity, the
same attention should be given to antimicrobial components of local agents.
In the third phase of wound healing process surgeons use ointments and creams to
provide a moist wound environment. For example: methyluracyl ointment solkoseril,
aktovegin.
Thus, the adequate choice drug for the treatment of wounds and wound infections
will ensure a best recovery of the patient.
PATHOPHYSIOLOGICAL BASIS OF ACUTE EROSIVE-ULCERATIVE
LESIONS OF THE GASTROINTESTINAL TRACT IN VICTIMS OF SEVERE
BURNS
Umarova S., Omoniddinova U. - the 3rd year students
Scientific leaders – Ostyakova M.E., Kostina V.V.
Links of the pathogenesis of acute erosive-ulcerative lesions of the gastrointestinal
tract in suffered from extensive burns, despite the results of numerous researchers, till now
are not accepted.
The pathogenesis of acute erosive-ulcerative lesions of the gastrointestinal tract in the
burned caused by ischemia of the wall of the gastrointestinal tract, violation of mesenteric
of blood flow, the emergence of edema and violation of the integrity of the mucous
membrane, and also the violation of the motor-evacuation function of the stomach, change
intraluminal gastric acidity, the influence of complex metabolic processes – the phenomena
of endotoxicosis, exchange of histamine, a direct participation of the products of lipid
peroxidation in the pathogenesis of burn disease.
Many etiopathogenetic factors of sharp erosive and ulcer defeats at development of a
burn disease exert mutually burdening impact at each other, thereby oppressing protective
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mechanisms of mucous a stomach and a duodenum even more (production of slime,
bicarbonates, a condition of a gastric blood-groove, power balance of cages mucous,
providing regeneration, and also production of acid function of a stomach and production
of humoral factors of protection). It leads to the strengthened influence of factors of
aggression, promoting, thus, formation of sharp erosion and ulcers which very often are
complicated by bleeding.
New insights about the pathogenesis of the acute erosive-ulcerous lesions of the
stomach and duodenum in hard burned, will effectively affect the protective properties of
the mucous membrane.
POSTINJECTION COMPLIFICATION
Umarova S., Omoniddinova U. – the 3rd year students
Scientific leaders – Dr.Med.Sc., Prof. Volodchenko N.P., Kostina V.V.
Postinjection complications attracted the attention of doctors over a hundred years
ago, immediately after the invention of the syringe in 1853 and the first injection in 1855.
The increase of volume of the public medical aid, increasing of its accessibility, the
emergence of new drugs are accompanied by a constant increase in the number of
performed injections. Along with the necessary therapeutic effect there is observed
undesirable consequences, complications of intravenous interventions - infiltrates,
abscesses and cellulitis, the number of which is increasing. The widespread adoption in
currently practice medicine of disposable syringes greatly facilitated and simplified the
procedure for intramuscular and subcutaneous injection. However, the incidence of
postinjection complications and their treatment are still one of the most pressing problems.
Postinjection suppurative complications are among the most frequent iatrogenic
purulent diseases. It often develops after intramuscular administration of a drug or as a
result of contact with the drug in the soft tissue in violation of art intravenous or intraarticular administration. At the basis of the development of post-injection suppurative
complications are often the injection flaws: violation of aseptic conditions, the wrong
choice of area or depth of injection, failure to comply with the breeding mode, infusion
rate, or an introduction to the soft tissues of the drug intended only for intravenous or intraarticular injections. Intramuscular drugs which most often causes postinjection purulent
complication - the concentrated solutions of nonsteroidal anti-inflammatory drugs (50%
solution of sodium metamizol), 20% magnesium sulfate solution, 10% calcium gluconate
solution.
In order to prevent postinjection complications one should avoid repeated
administrations of drugs in one place, periodically change the injection side, because
repeated administration of drugs leads to injury to muscle tissue by (medicine or needle)
and to the development of an abscess even in compliance with all the rules of asepsis.
In recent decades, there has been significant success in the treatment of septic
postinjection complications due to the introduction of the practice tactics of active surgical
treatment, including radical surgical treatment of purulent focus with additional methods
wound treatment and modern dressings, early wound closure using sutures or skin plasty,
adequate antibiotic and general intensive care.
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TOXIC EFFECTS OF HEAT AND COLD IN THE ORGANISM
Umarova S., Omoniddinova U. – the 3rd year students
Scientific leader - Prof. Korshunova N.V, post – graduate student Litovchenko E.A,
Kostina V.V
The human body can be exposed to stressful environmental factors, including
hyperthermia and hypothermia, which are extreme in nature.
Overheating and overcooling, which are the most important stress factors, influence
the subcellular structures of the body and contribute to the activation of lipid peroxidation
(LPO) and the accumulation of lipid peroxidation products - diene conjugates, Schiff bases,
malondialdehyde, etc. For the proper functioning of the body in different environmental
conditions it is very important structural and functional maintenance of membrane
integrity, and an increased content of LPO products not only leads to modification, but also
to damage of biological membranes. It should be noted that lipid peroxidation, as a
metabolic process intact membranes of organs and tissues, only begins with the appearance
of free radicals, which can be formed in biological systems, autoxidation in unsaturated
fatty acids or the reaction between oxygen and reducing agents.
According to some authors, the destruction of the membrane is influenced by the
simultaneous action of three factors: the intensification of free radical oxidation, activation
of phospholipase and detergent action of excess fatty acids. As a result, celebrated disorders
barrier function of membranes, cell metabolism and ionic balance. This appears in change
of the system features a variety of transporting ions, especially Ca-ATPhase and Na. KATPhase. Increased activity of the latter is proved under stress and is associated with
membrane lipids mediated by regulating the action of Mg-ATPhase.
Regulatory functions in violation of these perform antioxidant system, as with a
decrease in the activity of antioxidant redundant system of the organism increases the
intensity of lipid peroxidation.
Thus, the action of heat and cold leads to increased activation of lipid peroxidation
products of which lead to the accumulation of aldehydes, ketones, fatty acid oxidation,
causing structural and functional destabilization of the membrane with all the
consequences - an irreversible inactivation of membrane bound enzymes and changes in
membrane permeability up to break and cell death.
CHORIOCARCINOMA
Umarova S., Omoniddinova U. – the 3rd year students
Scientific leaders – Cand.Med.Sc. Levchenko N.R., Kostina V.V.
Choriocarcinoma- is a malignant tumor that develops from trophoblastic epithelium.
This tumor has been known to doctors for a long time, but only in 1886 the Moscow
pathologist M.N.Nikiforov found that it developed from the epithelium of the chorionic
villi, ie from fetal tissue, not from the mother. The tumor was named Choriocarcinoma.
Choriocarcinoma may develop after a molar pregnancy (at which the death of the
embryo and the placenta villi grow in the form of bubbles filled with liquids), as well as
without prior molar pregnancy after induced abortion, ectopic pregnancy, spontaneous
abortion, or after normal delivery. The most adversely flows tumor, which developed after
birth. The latent period (time from the end of a pregnancy up to the first signs of the disease)
in most cases, is non-existent or is 1-2 months, but in described the cases where the latent
period was 9 years and even 21 years after the abortion. Consequently, Choriocarcinoma
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is observed predominantly in women of childbearing age, it rarely develops after 40 years,
isolated cases occur after menopause.
Morphological picture Choriocarcinoma looks motley assembly of sponge on a
broad basis, at the location of a mucous or serous membrane assemblies shine in a dark
cherry formations. Microscopic Choriocarcinoma consists of cytotrophoblast cells and
syncytiotrophoblast polymorphic giant cells. Stroma in Choriocarcinoma is absent, and the
vessels are of the cavities form lined by cells of the tumor itself. In this regard, multiple
hemorrhage and necrosis in the tumor tissue are determined. The structure also determines
the tumor of early and rapid metastasis. Choriocarcinoma is called ass metastatic disease.
Metastases are hematogenous in 80% of the lungs. In 30% of patients it is determined
retrograde hematogenous metastases in the vagina, with the characteristic form of knots of
dark cherry color. Also it is described the pelvic bone metastases, in brain, liver and other
organs.
Choriocarcinoma is one of the most malignant tumors but is well treated by a
combination of chemotherapy and hysterectomy, except when it develops after a normal
pregnancy. In these cases, the prognosis is extremely unfavorable.
RAPID TEST CARDIO PBFA
Natpit A. – the 4th year student
Scientific leaders - Cand. Med. Sc. Kostrova I.V., Kostina V.V.
Express test "Cardio PBFA" is a test system for rapid "bedside" definition of high
levels of early cardiomarker of cardiac protein, binding fatty acids in whole venous
blood. Cardiac protein, binding fatty acids (PBFA) is a cardiospecific with low
molecular weight, cytoplasmic protein (15 kD) responsible for binding and transporting
fatty acids within cells. In the blood of healthy people there constantly circulates a small
amount of PBFA. The upper limit of normal is 6 ng/ml, while the background level
varies depending on the age, sex and circadian rhythm. Rapid test of Cardio PBFA
allows with a high degree of reliability to verify acute myocardial infarction (AMI) after
2 hours from the start of symptoms and can be used for the early differential diagnosis
of AMI. From a practical point of view, this is particularly important in patients with
AMI without ST-segment elevation. This technique due to its high sensitivity and
specificity makes it possible to identify early patients at high risk and an unfavourable
outcome, early treatment, and fundamentally affect the prognosis in these patients. In
addition, Cardio PBFA can be used to confirm the diagnosis in difficult cases, such as
atypical clinical presentation, with questionable ECG data, complicating the diagnosis
of myocardial infarction, and to exclude diagnosis of myocardial infarction in the first
days when patients are with similar clinical symptoms. The use of this test system does
not require learning, testing can be performed by any health care provider as by directly
treating physicians and nursing staff. Knowing such characteristics of Cardio PBFA as
simplicity in the formulation of the test and interpretation of results, speed of obtaining
the result, no need for special conditions and hardware support, I believe that this
technique can successfully be used in a hospital environment (emergency room, in any
medical Department - intensive care, cardiology, therapy, etc.) and at the prehospital
stage (when examination of the patient at home, on admission to hospital in the car of
EC, in the clinical diagnostic laboratory), when there is the greatest number of
difficulties in the differential diagnosis of ACS.
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FIBRINOUS INFLAMMATION
Sun A., Moiseeva S., Davidova D. – the 3-rd year students
Scientific leaders - Cand. Med. Sc.Menshchikova N.V., Kostina V.V.
It is characterized by the formation of exudates that contains fibrinogen, which is
converted in injured tissue to fibrin. Inflammation is often localized on the serous and
mucous membranes. Causes of fibrinous inflammation - bacteria, viruses, chemicals
exogenous and endogenous origin.
Among the bacterial agents - the development diphtheria Corynebacterium,
Shigella, mycobacterium tuberculosis.There are two varieties of fibrinous inflammation:
croupous and diphtheritic.
Croupous inflammation often develops on a single-layer epithelium of the mucous
or serous membrane. This fibrinous pseudomembrane is thin, easily removable.For
example, fibrinous inflammation of the pericardium figuratively is called “hairy” heart.
Diphtheritic inflammation develops in the organs covered by stratified squamous
epithelium, or a single layer of epithelium with loose connective tissue foundation that
promotes deep tissue. In such cases, the pseudomembrane is thick, it is difficult to removed,
there is a deep tissue defect in its rejection.
On the mucous membranes the pseudomembrane is rejected and form ulcerssurface with lobar inflammation and deep in diphtheritic. Superficial ulcers are usually
completely regenerated, scars are formed during healing of deep ulcers.
On serous membranes fibrinous exudate can be melted, but more often it is
subjected to the organization with the formation of adhesions between the serous sheets. It
may happen completely overgrown of serous cavities - obliteration.
HYGIENIC ESTIMATION OF THE POWER OF PRE-SCHOOL AGE
CHILDREN
Denishchik K., Davidova D., Moiseeva S. – the 3-rd year students
Scientific leaders - Prof.Korshunova N.V., Kostina V.V.
Protection and promotion of children's health is a top priority in any society,
because children determine the life potential of society in the future. According to the
Scientific Center of RAMS, no more than 15% of the child population can be considered
healthy. Children of all age groups have the preferential growth of chronic pathology.
The actual power of healthy preschool children affects their nutritional status, it is
a complex clinical, anthropometric and laboratory parameters that characterize the
proportion of muscle and body fat mass. It is found that an insufficient protein intake from
food is a risk factor for the formation of body composition.
To ensure the children by quality balanced nutrition in preschool institutions the
"Collection of technological standards, recipes of dishes and food products for preschool
institutions and children's health institutions" should be used.
Nutrition is one of the most important factors, which operates from the moment of
birth to the last days of life and contributes in the formation of health. Quantitative and
qualitative indicators of power define the processes of growth, development and
functioning of the central nervous system, adaptive immunity to infections and unfavorable
environmental factors.
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HYPOBARIC EXOGENUS HYPOXIA
Davidova D., Moiseeva S., Denishchik K. – the 3-rd year students
Scientific leaders - Assoc.Prof., Cand. Med. Sc. Maximenko V.A., Kostina V.V.
Hypoxia - a typical pathological process. It is a result of failure of biological
oxidation, which leads to disruption of energy supply functions and plastic processes in the
body. In etiology it is identified a number of types of hypoxia, they are combined into two
groups: exogenous and endogenous.
By lowering of the barometric pressure it is called hypobarometric exogenous
hypoxia. The reasons for its occurrence: a decrease of barometric pressure during the ascent
to altitude (more than 3000-3500 m, where the air pO2 is reduced to about 100 mm Hg) or
in a pressure chamber. Under these conditions it is possible to develop either a mountain
or altitude and decompression sickness.
Mountain sickness occurs when climbing in the mountains, where the body is
exposed not only the low oxygen content in the air, but the reducing of barometric pressure.
Altitude sickness occurs in people, raised to a great height in the aircrafts, and in reducing
pressure in the pressure chamber.
Decompression sickness occurs when a sharp decrease in of barometric pressure
(for example, due to depressurization of aircraft at an altitude of more 10000-11000m).
This forms for the life-threatening condition characterized by mountainous and highaltitude sickness or acute fulminant.
PATHOLOGICAL ANATOMY OF KAPOSIS SARCOMA
Usoltseva A., Sadykova N., Denishchik K. – the 3-rd year students
Scientific leaders - Cand.Med.Sc.Menshchikova N.V., Kostina V.V.
Kaposis sarcoma (angiosarcoma, or multiple hemorrhagic sarcomatosis) is
presented as numeros malignant neoplasms of derma.
Typically, the tumor has a purple color, but the color may have different shades of
red, purple or brown. The tumor may be flat or slightly rise above the skin, it is painless
spots or nodules. It is always located on the skin, less often - on the internal organs.
Kaposis sarcoma is often associated with damage of the mucous membrane of the
palate and the lymph nodes. Detection of Kaposi's sarcoma in HIV infection provides the
basis for the diagnosis of AIDS.
Tumor structure is characterized by a variety of randomly distributed thin-walled
neogenic vessels and bundles of spindle-shaped cells. The vascular nature of the tumor
dramatically increases the risk of bleeding.
Kaposis sarcoma - a special type of tumor, which often requires not only the
verification of the diagnosis but its treatment. Treatment of Kaposis sarcoma is usually
palliative, that is aimed only at reducing the symptoms.
SYNDROME THE CROSSING OF BRONCHIAL ASTHMA AND COPD
Lopatina E., Ondar S. – the 6th year students
Scientific leaders - Dr.Med.Sc. Prikhodko O.B., Cand.Med.Sc. Smorodina E.I., Kostina
V.V.
Chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA) are
widespread in the world and for mankind are enormous social, demographic and economic
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problem. The combination in one patient asthma and COPD is referred to as crosssyndrome BA - COPD. Patients with overlap-syndrome - a COPD patients with increased
reversibility of obstruction, and (or) smoking asthma patients with irreversible airflow
obstruction.
Patients with symptoms like asthma and COPD experience frequent exacerbations,
have a poor quality of life, a more rapid decline in lung function and a high mortality rate
compared with separately taken patients with asthma and COPD. It is reported on the
prevalence of this condition in the range of 15 up to 55% with variations depending on
gender and age. The frequency of established competing by physician diagnosis of asthma
and COPD amounted up to 15-20%.
The first step in the diagnosis of such conditions is to identify patients at risk of,
or substantial likelihood of chronic respiratory disease and to exclude other potential causes
of respiratory symptoms. Signs that allow to suspect a chronic disorder of the airways, the
following: a history of chronic or recurrent cough, sputum, shortness of breath or wheezing
or recurrent lower respiratory tract infections; diagnosis of asthma or COPD, previously
set by the doctor; treatment with inhaled medication in history; smoking history; exposure
of harmful environmental factors such as pollutants, airborne, at work or at home.
Important for the evaluation of patients with suspected chronic airway disease is
spirometry. Spirometry is used to confirm the chronic airflow limitation, but is of limited
value in the differential diagnosis between asthma with fixed airflow obstruction, COPD
and overlap-symdrome.
Treatment should include inhaled glucocorticosteroids (in a low or moderate dose,
depending on the severity of symptoms). It should be also continued treatment by β2agonists long-acting, if the patient has already received them, or they should be added to
the treatment. If syndromal diagnosis allows to suspect COPD, you must assign the
appropriate symptomatic treatment with bronchodilators or combined therapy, but should
exclude monotherapy.
BRONCHIAL ASTHMA IN PATIENTS IN THE POSTPARTUM PERIOD
Borodinа K. - the 6 th year student
Scientific leaders - Dr.Med.Sc. Prikhodko O. B., Cand.Med.Sc. Goryacheva S. A., Kostina
V. V.
In recent years, worldwide there is an increasing interest to the problem of
diagnostics and treatment of bronchial asthma during the gestational period. The aim of
this work was to determine the clinical and functional characteristics of bronchial asthma
during pregnancy and in the postpartum period.
There were monitored 102 patients with bronchial asthma in the dynamics of the
postpartum period from the 3 months up to 3 years. The dynamics of bronchial asthma in
gestational period: worsening was observed in 44% of patients, often with non-allergic and
mixed forms of the disease, without significant dynamics – in 39.2%, and improvement in
the 9.8%. To the weighting of BA course given: the presence of allergic rhinitis, chronic
diseases of otorhinolaryngologic and respiratory organs are the signs of severe duration of
BA.
In the first three days after delivery, exacerbation of asthma was observed in 6
(5.9%) of patients, within the next 2-4 weeks at 34 (33,3%), 2-4 months in 24 (25.3%) and
after 6 months in 16 (15.7 per cent). In 10 (9,8%) of patients, bronchial asthma symptoms
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resumed in one year after childbirth. At the same time 35 (34,2%) of patients showed
improvement after childbirth, 42 (41,2%) had no changes.
It should be noted that the improvement after the delivery was in patients with
partially or completely controlled course of bronchial asthma during pregnancy.
Aggravation of BA course after birth was diagnosed in 25 (25,5%) patients with moderate
and severe bronchial asthma.
Thus, the influence of the following factors on the dynamics of the BA course during
gestation and the postpartum period: the severity of the disease, presence of extrapulmonary allergic diseases, polyvalent sensibilization, of chronic pathology of
otorhinolaryngologic organs, ARVI and the extent of fulfilment of patients of medical
recommendations.
CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF ACUTE
INTESTINAL INFEСTIONS CAUSED BY PROTOZOA
Borodinа K. - the 6 th year student
Scientific leaders - Soldatkin P. K., Kostina V. V.
Duration of many intestinal parasitosis is characterized by scarce clinical symptoms
and lack of pathognomonic symptoms.
Amoebiasis - antropologia infestation, characterized by ulcerative lesions of the
large intestine, extraintestinal lesions in the form of abscesses in various organs. Infection
occurs in using of infected cysts water, fresh vegetables and herbs.
It is characteristic general malaise, mild abdominal pain, poor appetite, loose stools
– 7 - 10 times a day, mushy stool mixed with transparent mucus and blood, remind of
raspberry jelly. The mucus is viscous, it sticks to the bottom of the vessel. There are
characteristic cramping pain sin the abdomen.
Giardiasis: transmission path – water, contact-household. It is manifested by a
sudden diarrhea with fever, nausea, vomiting, loss of appetite. In the beginning stool is
copious, watery, frothy, with undigested food, then the stinking, floating. There are many
mucus in stool of biliary acids, stained in green or "white lumps" of colloid salts.
Balantidiasis is zoonotic protozoal disease characterized by ulcerative lesions of the
large intestine. The source of the pathogen are pigs, sick people and carriers. Start is acute
(rapid) with increasing of temperature to high numbers, headache, nausea, repeated
vomiting, progressive weakness, constant pain in abdomen, flatulence, diarrhea. Stool is
copious, fluid, often with blood, pus, putrid odor from 3-5 up to 15-20 times a day.
Cryptosporidiosis: source is farm animals, cats, dogs, a sick person, a carrier of
Cryptosporidium oocysts. In patients with normal immune systems start of acute with
profuse ("choleriform") watery diarrhea without pathological impurities and foul-smelling.
Thus, knowledge of the clinical and epidemiologic features for proteose will allow
to timely diagnose and prescribe the appropriate specific therapy that will prevent the
development of severe duration.
GROUPS OF CHILDREN'S HEALTH
Ermolaeva D., Pechyorskaya Yu., Tsydendambaeva S. – the 3-rd year students
Scientific leaders - Gosteva L.Z., Kostina V.V.
The term "group health" is largely conditional and reflects the state of health of the
child on the basis of data.
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Currently, the distribution of children's health groups is carried out on the basis of
instructions by a comprehensive assessment, the health of children, approved by the Order
of Health cure Ministry from Russian service 30.12.2003 № 621. In accordance with this
document an integrated system of health assessment is based on four basic criteria:
• The presence or absence of functional disorders and (or) chronic diseases;
• The level of the functional state of the main systems of the body;
• The degree of the body's resistance to unfavorable external influences;
• The level of development achieved and degree of it`s harmony.
Depending on the health condition of children can be attributed to the following
groups: 1 group - children who do not have deviations in health status
2 group - children with any functional changes, most often associated with uneven
growth and development
3 group - children with chronic diseases in the stage of compensation
4 group - children with chronic diseases in the stage subcompensation
5 group - children with chronic diseases in the stage of decompensation. As a rule
these are children with disabilities.
Children with the 1st and 2nd teams when entering the children`s establishment
visit it on a general basis and have no restrictions. Pupils from the 3rd health group it is
often required the appointment of a special diet and limitation of physical activity. In the
process of monitoring of child health group may vary depending on the dynamics of the
state of health of the child.
TRANSPLANTATION OF "GENDER" ETHICAL ASPECTS
Ermolaeva D., Pechyorskaya Yu., Tsydendambaeva S. – the 3 rd year students
Scientific leaders - Grebenyuk V.V., Kostina V.V.
Purpose: 1) To read the normative - ethical aspects of the problem of gender
transplant; 2) to conduct a survey among students of Amurskaya SMA, in order to identify
the views on the subject; 3) to interview the person of changed sex.
Problems of transsexuals: the need to be seen by a psychiatrist is humiliating,
discrimination in the field, a lack of understanding from family and loved people.
Ethical conflict of Principles of Medical Ethics, totality and integrity of the
individual, it protects the integrity of the individual. The human body is indivisible
independently functioning of unified whole. However, many experts believe that the
sacrifice of the body for the sake of the integrity of psychological stability is unjustified.
Therefore, there are still debates on the theme of sex-change operations.
The survey results among the students of the Amurskaya SMA: what do you think
about the sex-change operation? 88% of respondents answered negatively, 12% positively; whether is transplantation of gender perspective in Russia? 98% believe that it
is not promising, 2% - is promising; do you have any friends who have made such an
operation? 99.7% - no; 0.3% - yes.
Conclusion: The majority of students have a negative attitude towards transgender
operations, and believe this trend in surgery is not promising in our country. In total 0.3%
of the surveyed students are personally familiar with patients after transplantation of "sex."
Implementation of such operations will for a long time cause a debate in society.
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ENZIMODIAGNOSIS
Voynitskiy A. - 2nd year student
Scientific leader - Cand. Med. Sc. Egorshina E. V., Kostina V. V.
Enzimodiagnosis is disease diagnosis (or syndrome) based on the determination of
enzyme activity in human biological fluids. Enzimodiagnosis principles are based on the
following positions. At damage of cells in the blood or other body fluids increases the
concentration of intracellular enzymes of damaged cells. The number of released enzyme
is sufficient for its detection. The activity of enzymes in biological fluids detected when
damaged cells, is stable for a sufficiently long time and is different from the normal values.
A number of enzymes has priority or the absolute localization in certain organs. There are
differences in the intracellular localization of a number of enzymes. Typically, these
enzymes perform its function within the cell and have physiological significance in plasma.
In a healthy person the activity of these enzymes in the plasma is low and sufficiently
constant as speed ratio continuously release from the cells and their speeds destructions.At
many diseases there is damage of cells and their contents, including the enzymes which are
released into the blood. The reasons that cause the release of intracellular contents into the
blood, include violation of the permeability of the cell membranes (inflammatory
processes), or a violation of the integrity of cells (necrosis) .Ferments that catalyze the
same chemical reaction, but differ in the primary structure of the protein, are called
isoenzyme. They catalyze the same type of reactions with essentially the same mechanism,
but differ from each other by kinetic parameters, activation conditions, peculiarities of
apoenzyme and colnzynus connections. Isozenymes differ in primary structure of the
protein molecule and, accordingly, by physico-chemical properties. On the differences in
the physical and chemical properties methods of determining isoenzymes are based.
TUMORS OF THE HEART. MYXOMA OF THE LEFT ATRIUM
Malynova I., Zolotareva J. – the 4th year students
Scientific leaders - Cand. Med. Sc. Kostrova I. V., Kostina V. V.
Tumors of the heart - a rare disease with the polymorphic clinical picture. The
incidence of primary and secondary tumors of the heart are up to 0.1 and 6% respectively.
Myxoma of the heart - the primary intracavitary histologically benign tumor that
occurs at any age, but the most frequently occurs in the age from 30 up to 60 years old,
presenting 2-4 times more often in women than in men. Myxoma is most frequently
localized in the left cavity (75%) or right atrial (20%) and rarely in the heart ventricles.
Clinically myxoma of the left atrium is shown by diverse clinical symptoms,
simulating a number of diseases of the cardiovascular system.
For more accurate diagnosis there is a magnetic resonance tomography. Moreover,
emboli obtained from a surgical interference are histologically analyzed.
Treatment. Radical treatment involves surgical removal of myxoma of
intracavitary cardiac tumors. Due to the high risk of thromboembolic complications and a
sudden death there is a need for an immediate surgery just after diagnosis.
CONGENITAL DEVELOPMENT IN THE AMUR REGION. VENTRICULAR
SEPTAL DEFECT
Belikin A., Dumen-Bayyr A. – the 4th year students
Scientific leaders - Cand. Med. Sc. Kostrova I. V., Kostina V. V.
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Congenital heart disease (CHD) is a defect in the structure of the heart and (or)
large vessels that is present from birth. The majority of defects disrupt the flow of blood
inside the heart or the large and low circulation. Heart defects are the most common
birth defects and are the leading cause of infant mortality from the malformation.
Ventricular septal defect (VSD) — a congenital heart defect characterized by the
presence of a defect between the right and left ventricles of the heart. Intracardiac
hemodynamic disorders in VSD begin to form shortly after birth, as a rule, on 3-5 day
of life. In the early neonatal period, the heart murmur may be absent due to equal
pressures in right and left ventricles because of the so-called neonatal pulmonary
hypertension. Gradual decrease of the pressure in the system of pulmonary artery and
right ventricle creates the difference (gradient) in pressure between the ventricles as a
result there is discharge of blood from left to right (from a region of high pressure to
low pressure). The additional volume of blood flowing into the right ventricle and the
pulmonary artery leads to the overflow vessels of the pulmonary circulation, where
develops pulmonary hypertension.
ABORTION. CLINICAL INDICATION AND CONTRAINDICATION
Mironenko N., Yusibova R. - the 3-rd year students
Scientific leaders - Grebeniuk V.V., Kostina V.V.
Relevance: the problem of abortions in our country was rising for along time and
now, thanks to the speech in public of Ann Kuznetsova the Commissioner for the rights of
the child at the President RF, this question has again become relevant. "The whole world
is not for the first year opposed such phenomena as abortions, and we support this position,
of course, believe that this issue requires a systemic approach," - said Kuznetsova. It is
really so, but totally to prohibit abortions is not necessary , because there are certain
indications and contraindications for such intervention as abortion. In surgical 81 abortion
is to 100 deliveries in Amur region. Abortion is the termination of pregnancy in terms up
to 28 weeks, counting from the first day of one’s mensis.
On medically evidence abortion is held regardless of its period if pregnancy and
childbirth can worsen the health of the woman and threaten her life, or if there are
abnormalities of the fetus. The testimonies set obstetrician-gynecologist together with
specialists of the worthy profile (general practitioner, surgeon, oncologist, psychiatrist,
etc.) and the head of the medical institution after the examination of the patient in the
hospital. A woman writes a application that regards the medical commission.
Contraindications to medical abortion can be a result of inflammatory processes of
sexual organs, in the presence of purulent foci, irrespective of their localization, acute
infectious diseases, late-term pregnancy. In the later stages abortion is contraindicated if
the termination of pregnancy in this period is more dangerous for life and health than
continuing pregnancy and childbirth. The term is less than 6 months after a previous
abortion.
FEATURES OF THE CURRENT OF THE MYOCARDIAL INFARCTION AT
PATIENTS WITH THE DIABETES MELLITUS
Pronina D., Chervova Y. – the 3rd year students
Scientific leaders – Dr.Med.Sc., Prof. Menshikova I.G., Kostina V.V.
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Damage of heart at the diabetes mellitus (DM) is frequent and prognosticly an
adverse complication of a disease. Into the forefront in clinic of "diabetic heart" a coronary
failure acts. The main features of clinic of the myocardial infarction (MI) at DM are the
following: a female dominance among patients, the larger centers of defeat, frequent
repeated heart attacks, tromboembolic episodes, development of a heart failure.
Mainly, three factors explaining an originality of a clinical picture of a disease
participate in a myocardial infarction genesis at DM sick: 1) defeat of coronary vessels,
including shallow intramuralny branches; 2) change of coagulating and anticoagulative
system of blood which can be regarded as a pretrombotichesky state; 3) large fluctuations
of a glycemia.
Development of a sharp coronary syndrome often provokes a hyperglycemia by
increase in level of vasoactive cytokines which can increase insulin resistance and reduce
insulin secretion. Deficiency of insulin reduces utilization of glucose in a myocardium,
causing shift of metabolism towards fatty acids that leads to increase in oxygen
consumption by a myocardium and aggravates the hypoxia phenomena, making heavier a
current of them, provoking complications of the sharp and subacute period, such as
cardiogenic shock, arrhythmias.
Patients with DM and ischemic heart disease differ in smaller ability to development
of collaterals in this connection they note more frequent development of postinfarction
stenocardia and distribution of a zone of a necrosis with decrease in pump function of a
left ventricle. Dystrophic changes and violation of the neuroreceptor device provoke lowexpressiveness of a pain syndrome at most of patients in the sharp period of a disease. It,
in its turn, can become one of the reasons of overdue diagnostics to them that also causes
heavier course of heart attacks and high percent of a lethality.
Thus, it is obvious that DM exerts adverse impact on a current of them, increases quantity
of complications. It dictates need of searching of the most efficient methods of
diagnostics and treatment of this combined pathology.
PATHOMORPHOLOGY OF SILICOSIS
Krylova E., Melkonyan A. - 4th year students
Scientific leaders - Cand. Med. Sc. Dubyaga E.V., Cand. Med. Sc. Goryacheva S.A.,
Kostina V.V.
The pulmonary changes due to pathological inhalation of dust particles, so called
pneumoconiosis, has long been observed by medical scientists. But it is only the
investigation of the last decade that have supplied us with a more comprehensive and
thorough knowledge of the more intricate pathological anatomy and pathogenesis. As
numerous investigations have conclusively shown that nearly all forms of
pneumoconiosis are due to the silica present in the particles of stone most forms of
pneumoconiosis are nowadays designed by the common name silicosis. The purpose of
this work is to comprehend the pathomorphology of silicosis in Amur region.
The first response to the appearance of silica in the acinus is the accumulation of
macrophages. If the inhalation of dust is massive then the macrophages fill the lumen of
bronchioles and surrounding alveoli. If it's a slow development then at an early stage in
the lung tissues of the upper sections - mainly in the area of the gate - are revealed
multiple tiny nodules that give fine-grained view of the lung parenchyma. Nodular form
occurs with a high content of free silica in dust and prolonged exposure to dust. In severe
case of silicosis nodules coalesce into large silicatic nodes that occupy a large part of
93
the lobe or the whole lobe of the lung. This form is considered as a tumorous form of
silicosis.
If a diffusely sclerotic form takes place then typical silicatic nodules in the lungs
are not present or if they are, then there are very few of them, though these nodules are
often found in bifurcation lymph nodes. This form occurs by inhalation of industrial
dusts with little free silica content.
ADDICTION ON SOCIAL NETWORKING
Piura D., Dolgoruk E. – the 4th year student
Scientific leaders – Brush N.G., Kostina V.V.
Internet dependence (Internet addiction) — the obsessional aspiration to use the
Internet and excess use of it, spending a large number of time in network. Internet addiction
is not a mental disorder by the medical criteria (MKB-10).
It is consider that the most common type of Internet-addiction need of
uninterrupted communication. It can be forums, social networks and chats.
Recently, on the World congress of psychiatrists in St. Petersburg, scientists
suggested to consider addiction on the Internet and social networks the chronic disease
required serious treatment
Addiction on social networks is similar to alcohol or drug addiction — they
develop on one mechanism. The only difference is that in internet-addiction we do not find
signs of chemical dependency from toxic substances. So, such people seldom come into
field of vision of physicians.
Stage of development of Internet addiction:
• At the first stage user gets acquainted with the Internet, chooses the option of
virtual reality suitable for itself.
• Gradually, it forms special style in network compensating to it for that deficiency
of communication or information which is not enough in real life. Further, user begins to
spend more and more time in that reality which he or she choose.
• On thirds stage — signs and symptoms of Internet-addiction on the person. It
gradually becomes chronic.
The world's first support center for Internet addicts has become a center created an
authoritative scholar in such field - Kimberly Young, a professor of psychology at the
University of Pittsburgh.
In Russia, treatment of the Internet addiction is carried out too, but the list of clinics
involved in the rehabilitation of such patients is limited outside of Moscow and St.
Petersburg. Fact is that only a few wants to treat, because the majority of dependent either
don’t consider to be so or try to fight against the addiction independently.
INFLUENCE OF DIETARY SUPPLEMENT ON THE BASIS OF 350 MG OF LCARNITINE OF TARTRATE AND A 30 MG OF DIHYDROCVERTSETIN ON
PRODUCTS OF PEROXIDATE OF LIPIDS
Pchelina K. – the 4th year student, Mironenko A. – the 3rd year student, Sydorenko D. – the
2nd year student
Scientific leaders – Dr.Med.Sc., Prof. Dorovskikh V.A., Cand.Med.Sc., Assoc. Prof.
Anokhina R.A., Kostina V.V.
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The intensive physical activities which are followed by insufficient intake of oxygen
in fabric are a stress for an organism and cause activation of processes of peroxidate of
lipids while activity of antioxidant system becomes insufficient. In turn the РОL leads to
destruction of organic molecules, first of all lipids, and, respectively, membrane structures
of cages that often comes to an end with their death. We conducted a research on group of
10 athletes accepting dietary supplement (of 6 capsules a day for 4 weeks) on the basis of
a L-carnitine of tartrate and a dihydrocvertsetin.
According to control of physical working capacity at athletes there observed
statistically not significant (in case р<0,05) changes to the best. According to laboratory
blood tests increase in concentration of products of РL was revealed (hydroperoxide of
lipids, HMM, dien conjugates) at 75% of athletes in comparison with data before dietary
supplement acceptance, these changes are statistically significant (in case of р<0,01). Also
there is an increase in indicators of AOS (vitamin E, ceruloplasmin) at 50% of athletes that
is statistically significant (is noted in case р<0,01).
On the given indicators it is possible to judge about activation of РL of athletes, but
also and activation of system of antioxidant protection. For better assessment of results it
is necessary to conduct a research with bigger the number of athletes and with placebo
control.
ANATOMY OF PELVIS
Maltseva A. – the 1 – st year student
Scientific leaders – Zherepa L.G., Kostina V.V.
The bone pelvis represents a strong receptacle for internal genitals, a rectum, a
bladder and the tissues surrounding them. The female pelvis forms the patrimonial channel
where the born fetus moves ahead. In process of development of an organism there is a
change of volume and form of a pelvis. On development of a pelvis, as well as all on
organism in general, psychoemotional overloads, stresses, the concentrated sports study,
reception of hormones affect. Deformations of a pelvis can be caused by an osteomalacia,
tuberculosis and tumors of bones, fracture of pelvic bones, a rachiocampsis (scoliosis, a
kyphosis, coccyx fracture), and also congenital anomalies, a cerebral palsy, a poor
nutrition, a disease of rickets, a poliomyelitis.
The narrow, wide and deformed pelvis are concerned to anomalies of a bone pelvis.
At the improper maintaining, childbirth at pregnant women with anomalies of a bone pelvis
is accompanied by maternal and children's traumatism.
Now the expressed deformation and narrowing of a pelvis at women are rarely
noted. There are mixed forms of anomalies of a pelvis.
TOXOPLASMOSIS
Logvinova I. – the 1-st year student
Scientific leaders – Naumenko V.A., Kostina V.V.
Toxoplasmosis - a disease caused by single-celled parasite of toxoplasma
(Toxoplasma gondii). Up to half of the world's population is infected with toxoplasmosis.
In the USA 23% of the population are carriers, in Russia - about 20%, and in some
countries of the world - 95%. Infection of human beings occurs in close association with
the cat in the use of infected raw meat, as well as through contact with soil containing
oocysts that were there with cat feces.
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Toxoplasmosis - not an absolute indication for termination of pregnancy.
GALLBLADDER AND EXTRAHEPATIC BILE DUCTS IN NEWBORNS
Logvinova I. – the 1-st year student
Scientific leaders – Zherepa L.G., Kostina V.V.
Gallbladder in most cases is completely hidden by the liver. Lodge bubble may be
small or deep. The shape of the gallbladder is diverse. The most common is cylindrical or
pear-shaped, at least - spindle-shaped and S-shaped, the latter is often associated with the
unusual situation of the cystic artery.
Bundles. Occasionally (10%) is determined lig. cysticocolicum, which may be
located on one or both sides of the bladder.
Common hepatic duct sharply varies in length from 5 up to 18 mm, more often it
is the same length and diameter with cystic.
The common bile duct length is from 13 up to 22 mm (pars supraduodenalis - from
3 up to 5 mm, pars retroduodenalis - from 10 up to 23 mm) in diameter and 2 mm.
Lymph nodes (ranging in size from 1-2 up to 5-8 mm) are most common in the
neck of the gall bladder, the initial part of the cystic and common bile duct formation.
THE ASHERMAN’S SYNDROME
Kirillova Ya. – the 6th year student
Scientific leaders - Cand. Med. Sc. Sharshova O.A., Kostina V.V.
Nowadays, childless marriages remain an important medical and social problem.
The most relevant in modern obstetrics is the problem of miscarriage. Intrauterine
adhesions (Asherman's syndrome) - is a pathological fusion surfaces of the uterus due to
adhesions, resulting in deformation of the uterus, causing impaired menstrual and
reproductive function. Intrauterine adhesions are connective seam, soldered between walls
of the uterus and causing its deformation. In the presence of adhesions, normal
endometrium undergoes atrophic transformation. Intrauterine adhesions lead to the
disorder of menstrual function, create a mechanical obstacle to the promotion of sperm,
impair the conditions for the implantation of the ovum. Consequently there the main
manifestations of Asherman's syndrome appear - oligomenorrhea, secondary amenorrhea,
miscarriages and infertility. For the diagnostic it is used hysterosalpingography, ultrasound
diagnostics and hysteroscopy. The main treatment is surgery adhesiolysis. The probability
of pregnancy and child bearing at Asherman's syndrome depends largely on the stage of
the process and the reasons that lie at its core. So, the prognosis of tuberculous lesions of
the uterus is less favorable. At the same time the average of fertility restoration is relatively
high, probability it is about 75%.
BIOIMPEDANCE ANALYSIS IN PRACTICE OF PROGRAM HEMODIALYSIS
Kirillova Ya., Glushkova N. – the 6th year students
Scientific leaders - Cand. Med. Sc. Smorodina E.I., Anyushkin S.V., Kostina V.V.
Persistent hyperhydration is a key element in the emergence of left ventricular
hypertrophy, arterial hypertension, and high mortality from cardiovascular disease in
patients with end-stage renal failure, who are on program hemodialysis treatment.
Accordingly, the normalization of hydration sectors of body using ultrafiltration - is one of
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the main problems in the treatment of patients by dialysis. Euvolemia condition in dialysis
patients is determined by the term "dry weight". So far, the dry weight was determined
mainly on the basis of clinical observations, despite the subjectivity and imprecision of this
method. The most promising is the use of bioimpedance analysis (BIA), which allows to
evaluate not only the volumes of extracellular and intracellular fluids of body, but also the
value of lean and fat mass. Thus, the BIA seems reliable method of objectifization
hydration status in patients, who undergoing hemodialysis treatment program. Taking into
account the ease of condution and small dimensions, low cost of techniques, we can assume
that the BIA will take a leading position among the instrumental methods to assess the
degree of hydration and will become a standard method in routine practice of program
hemodialysis. Multi-frequency BIS, wherein more accurate results when evaluating the
fluid distribution by sector of the body, can be a useful tool for studying and monitoring
the parameters of body composition - lean and fat mass. These indicators allow to objectify
nutritional status, which is one of the main factors in the dialysis population, determining
the results of the treatment.
COMPLICATIONS AFTER AN ADENOMECTOMY
Mokrushina Yu., Kapustyanskay A. – the 4-th year students
Scientific leaders – Cand. Med. Sc. Velichko D.N., Kostina V.V.
Frequency of complications fluctuates within 8.8-18.8%. We will stop only
on the most serious, organic types of complications. Here there are: structure of an
urethra, its obliteration, formation of "prevesical"(wounded cavity between bladder
and resected proximal end of urethra), an urine incontience.
A simple stricture of a back part of an urethra is a the most frequent of latest
infravesical complications of an adenomectomy. In a clinical picture there is
observed difficulty of an emiction. It is only possible to assume the reasons of this
complication - early excision of a catheter and an urethritis. Treatment of this
complication - a bougieurage. At the present stage the sparing methods of treatment
of strictures of an urethra are developed and introduced in practice. The optical
urethrotomy and a transurethral electroresection, an internal blind urethrotomy
(Myuzo's ureterotome)are applied to them.
One more type of the remote complication of an adenomectomy of a prostate
of the organic nature - a residual cavity on the place of remote adenoma, a so-called
prevesical. If "prevesical" isn't followed by a stricture of a neck of a bladder or
urethra, it doesn't cause any clinical implications in most of patients. The clinical
picture of a disease when neck of urinary bladder stricture joins the complication
described above happens even more serious, that is the patient has bladder neck
strictures, "prevesical", an urethra stricture. The leading symptom is complicated,
with a straining, sometimes on drops, the emiction; the expressed pains in a
perineum and on the urethra course, long dribble of urine after an emiction.
INFLUENCE OF AN ELECTROMAGNETIC ON HEALTH OF THE PERSON
Mokrushina Yu., Kapustyanskay A. – the 4-th year students
Scientific leaders – Cand.Med.Sc.Goryacheva S.A., Dr.Med.Sc.Prikhodko O.B.,
Kostina V.V.
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The body of the person has its own electromagnetic field as any organism on
the Earth thanks to which all cells of an organism work harmoniously. Electromagnetic
radiations of the person are still called a biofield (his visible part — aura). Don't forget
that this field is the main protective membrane of our organism from any negative
impact. Destroying it, bodies and systems of our organism become an easy spoils for
any pathogenic factors.
If other sources of radiation, much more powerful, than the radiation of our
body, begin to affect our electromagnetic field, so chaos in an organism begins. It also
leads to cardinal deterioration in health.
And not only household appliances, mobile phones and transport can be such
sources. The big congestion of people has also considerable impact on us,also mood of
the person and his attitude towards us, geopathogenic zones on the planet, magnetic
storms, etc.
Feeble electromagnetic fields (EFF) by power of the 100-th and even
thousand shares of Watts of high frequency are dangerous to the person that intensity
of such fields matches with intensity of radiations of a human body at usual functioning
of all systems and organs in his body. As a result of this interaction own field of the
person is distorted, provoking development of various diseases, mainly in the most
weakened organism links.
The most negative property of electromagnetic signals is that they have
property to collect in an organism over time. At people, by the nature of activity there
is a lot of using various office equipment – computers, phones – decrease of immunity,
frequent stresses, dropping of sex activity, increased fatigue are revealed.
The circulatory system, brain, eyes, immune and sexual systems are mostly
subjected to influence of electromagnetic fields.
MOTIVATIONAL ORIENTATION OF PATIENTS WITH HYPERTENSION
Hotsanyan K., Kirillova Ya., Glushkova N. - 6th year students
Scientific leaders – Dr.Med.Sc., Prof. Pavlenko V.I, Kostina V.V.
Arterial hypertension (AH) is one of the most common diseases, the occurrence of
which is associated with a significantly increased risk of cardiovascular morbidity and
mortality. Despite the large number of used today antihypertensive drugs, effective control
of hypertension remains an urgent problem. Purpose of the study. To study the motivation
of patients with hypertension in the success of the treatment and conduct analysis of the
factors that determine its orientation.
Materials and methods. The study included a group of patients with hypertension degree
II-III, the disease duration from 4 to 25 years who were hospitalized in a specialized
cardiology department. There were 26 (52%) men and 24 (48%) women. Each patient
filled an individual case history showing demographic data, level of education, awareness
of the disease, the history of life, the presence of cardiovascular complications, prescribe
antihypertensive drugs with indication of the mode of application and duration of treatment
before hospitalization, and test a questionnaire motivation and fear of failure ( EOR).
Evaluation of patients with motivation to success of treatment was carried out using a
points system. There was determined gradation in the following groups: failure - when
typing - from 0 up 7 points, closer to failure - from 8 up to 10; closer to success - from 11
up to 13; fortune - more than 14 points. Conclusions. As a result it was found that the
majority of patients (62%) were motivated by the success of the treatment. Men with higher
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education, as opposed to women, there was a significantly low motivation for treatment (p
<0.05). If the experience of the disease for more than 15 years, the proportion of patients
with failure or closer to failure of treatment was 8.3%. It should be noted that it was the
only male person with a lack of awareness about the disease. Patients with II hypertension
stage were less motivated by the success of the treatment.
Among other factors that reduce the motivation to treatment, were: lack of
understanding of medical instructions (28%), fear of side effects and addiction to
medication (36%), the presence of comorbidity (54%) no symptoms of the disease (14%),
the denial of the existence of disease (12%), lack of confidence in the success of the
treatment (36) .Also, it was found that persons older than 50 years old are more motivated
to succeed in treatment than patients in the age range 40-50 years old.
Thus, the motivation is inducement to recovery, so keeping the doctor motivational
sphere of the patient will help to give some advice on the success of the treatment, which
will significantly improve treatment outcomes.
PROBLEM OF CHOICE OF HIP IMPLANTSIN MODERN TRAUMATOLOGY
Hotsanyan K. - the 6-th year student
Scientific leaders - Dr.Med.Sc Borozda I.V., Kostina V.V.
According to the World Health Organization the number of diseases grows with
increasing of life expectancy and general aging of population. In 2000, the worldwide
number of 60 years old people and older was 590 million persons, and in 2025 it will
exceed one billion people. The urgency of the problem every year increases.
The actual question of a endoprosthetics - a philosophy of construction, review and
selection of implants. The country has presented an extensive overview of hip implant
systems and different manufacturers used in Russia. endoprosthesis developments
underway in various areas of construction of the prosthesis elements, methods of fixation,
the use of different materials, various kinds of processing the surface of implants and a
variety of options for implant shapes that allows an Operating orthopedists choose from a
wide range of models of the products of a particular company (Scott D. F., 1996). The
choice of friction pairs for a particular patient is influenced by many factors related to the
patient's sex, age, weight, level of physical activity, risk factors - features of professional
work, and allergic reactions.
Conducted searches optimal friction pair, and marks a return to the metal friction pair,
as the most resistant to abrasion. Improved implant fixation in the bone bed technology
due to optimal shape and various deposition or coating.
The problem of returning to an active life for patients with hip injury was and remains
valid to this day. Thus, conservative management hip gives 80% negative results fractures,
hip surgery various osteosynthesis provides 20% to over 30% of failures and consolidation
occurs at the fracture avascular necrosis of the femoral head of 10% to 50% (A. Kaplan .,
1978; Gaiko GV, Reshetnikov AA, 1979; Movshovich IA, 1985; Nuzhdin VI, 1987; Gear
NA, 1992).
The emergence of the latest developments of domestic and abroad hip replacements
allows us to rethink the whole strategy of the management of patients with injuries and
diseases of the hip joint, to significantly reduce the periods of disability and rehabilitation,
to improve the quality of life of patients, returning them to an active lifestyle
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SURGICAL TREATMENT OF THE HIRSCHSPRUNG'S DISEASE
Hotsanyan K., Sharvadze N. - 6th year students
Scientific leaders – Cand.Med.Sc., Assoc.Prof. Vdovin O.B., Kostina V.V.
The relevance of the study Hirschsprung's disease remains one of the most severe
congenital malformation of the abdominal cavity in children requiring complex
reconstructive surgical procedures. The main clinical form of the disease manifests by
persistent constipation, on average, for about 20% of children under 1 year old and up to
25% of children older than 1 year old suffer from this symptom. [Mazurin AV et al. (2000),
Dubrovskaya MI, Shumilov PV, Mukhina G. et al. (2008)]
Modern surgical trends early and radical cure of congenital malformations in
newborns require revision of adopted a multi-stage treatment strategy with the imposition
of an intestinal stoma age- aspect [Hassan TA (2003), Eradnock T.J. (2010), Andrievskiy
A. (2012), Nayhus L. et al. (2014)].
The overall incidence of complications based on large specialized hospitals, with
extensive experience in the treatment of children with Hirschsprung's diseases, ranging
from 22.7% to 38.5%. Related to this there is the lack of generalized information on the
results of operational activities at the Hirschsprung's disease and its possible complications
and their treatment tactics. In a study of local physicians, 152 children have been diagnosed
with Hirschsprung's disease supershort segment. The dominant symptom - chronic
constipation in children, is not amenable to conservative therapy may be associated with
"supershort" form of Hirschsprung's disease. The share of these patients account for about
44.8% of all children with Hirschsprung's disease, and 6.2% in the population of children
with chronic constipation. [Svarich V.G.1, Kyrgyzstan I.V.2, Abayhanov RI]
To clarify the diagnosis in addition to X-ray, endoscopy, functional studies of the
colon it is necessary transanal biopsy of the rectal wall, which is the most reliable
diagnostic method for Hirschsprung's disease in adults. The best way surgery is abdominalanal resection of the rectum with bringing down the proximal colon to the anal canal, which
answers the requirements of radicalism (removal of hypo- or aganglionare zone). This
offered us kind of surgical treatment can reduce the number of postoperative
complications, promotes early restoration of motor-evacuation function of the colon and
the normalization of self-defecation. [Mirzakhmedov MM, Original Researches]
AWARENESS AMONG THE POPULATION ABOUT TUBERCULOSIS
Pnuykhtin O., Pnuykhtina M. - the 6-th year students
Scientific leaders – Cand. Med. Sc. Soluyanova I.P., Kostina V.V.
Tuberculosis is a serious threat to public health worldwide. Half of patients with
active tuberculosis representing a danger to others, do not appeal to medical institutions
and is able to infect 5 - 50 people per year. A favorable outcome of tuberculosis is possible
with early detection and timely treatment.
The purpose of the work: to determine the level of awareness among the population
about TB and to identify knowledge about the disease, methods of diagnosis, treatment and
prevention.
Using the compiled questionnaires 50 people (men 72%, women 28%) aged 18 – 60
years old were anonymously examined.
The results of the survey showed a low level of knowledge about the disease. People
want to know more about the disease, prevention and hygiene. In this regard, health
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workers should intensify health education work on a healthy lifestyle. Public awareness
lectures in schools, institutions of secondary and higher education, release of sanitary
bulletins in clinics, through the media, schools health.
PARTICULAR FEATURES OF VIRAL INFECTION ASSOCIATED
PNEUMONIA IN PREGNANT WOMEN
Sharvadze N., Khotsanyan K. – the 6th year students
Scientific leaders – Assoc. Prof., Cand. Med. Sc. Lazutkina E.L., Kostina V.V.
In 2009 during the epidemic of influenza A (H1N1) there was a significant increase in
cases of viral infection associated pneumonia among pregnant women. During this time 37
women were treated with CAP. Most of the women were in the 3rd trimester of pregnancy
- 70.4%. 9 persons (24.3%) had influenza A (H1N1) associated pneumonia, 5 (13.5%) influenza virus type A associated pneumonia, they represented the first group. 23 persons
(62.2%) with negative test results for the presence of influenza viruses were combined in
the second group. Among patients from the 1st group there was more severe course of
pneumonia in comparison with the 2nd one: severe course was observed in 7 patients
(50%), while in the 2nd group 3 patients (13%) had a severe course. In terms of destruction
of lung tissue in the 1st and 2nd group lobar pneumonia was more common – in 72% and
78% respectively. A clear physical picture was observed in 85.7% of women in the 1st
group and in 100% of cases in the 2nd group. There was one case with a fatal outcome of
patient L., 23 years old with total bilateral influenza A (H1N1) associated pneumonia,
complicated with acute respiratory distress syndrome, sepsis, multiple organ failure, at 28
weeks of gestational period.
During the influenza epidemic in 2016 11 pregnant women with respiratory disorders have
been treated. One pregnant had viral infection associated pneumonia and influenza A virus
(H1N1) has been identified in one case. In pregnant woman with viral infection associated
pneumonia severe course, segmental loss of lung tissue, a clear physical picture was noted.
TUBERCULOSIS IN HIV-INFECTED PEOPLE
Sharvadze N., Khotsanyan K. – the 6th year students
Scientific leaders - Zagny L.P., Kostina V.V.
Tuberculosis (TB) in patients infected with human immunodeficiency virus (HIV) is an
actual medical problem. WHO estimates that nearly 10% of newly diagnosed TB cases in
the world are combined with HIV, and TB is a major cause of death among HIV-infected
patients.
HIV-infection contributes the transition of infection caused by Mycobacterium
tuberculosis into active TB. For HIV-infected persons coinfected with M. tuberculosis risk
of active TB is 5-10% per year, whereas for people who are not infected with HIV the risk
is 5-10% throughout life.
As HIV infection progresses, CD4 count of lymphocytes is reduced by about 50-80 / mcl
per year that reduces the ability of the immune system to inhibit proliferation of local
spread of Mycobacterium tuberculosis in the body. Clinical manifestations of TB at the
early stage of HIV infection (CD4> 350 cells / mm) are similar to the symptoms of
secondary TB in HIV-negative patients. TB at the late stage of HIV infection (<200 cells /
mm) is characterized by the absence of mycobacteria in sputum, detection of infiltrative
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changes at fluoroscopy, but not cavities. In severe immunodeficiency extrapulmonary TB
incidence increases.
At active TB in HIV-infected patients the worsening of immunodeficiency is observed, any
opportunistic infection can be fatal. In these cases, TB is an indirect cause of death. TB is
the cause of death in 30% of patients with HIV / AIDS. In this regard, early detection and
treatment of TB in HIV-infected patients is necessary.
TRAUMATIC SHOCK AS A PROTECTIVE-ADAPTIVE REACTION OF
MAMMALIAN ORGANISMS
Sharvadze N. Babijchuk E. – the 6-th year students
Scientific leaders - Assoc. Prof., Dr. Med. Sc. Borozda I.V., Kostina V.V.
Although, historically, shock associated with traumatic injury has been evaluated through
knowledge of the 4 recognized shock patterns - cardiogenic, obstructive, distributive, and
hypovolemic - many trauma practitioners viewed traumatic shock as a unique fifth shock
pattern. Secondary to a systemic inflammatory response syndrome triggered by
endogenous danger signals, traumatic shock represents a unique pathological condition that
begins with multiple, usually blunt, trauma and may conclude with multiple organ
dysfunction syndrome and death. While varying mechanisms of injury may lead to
different presentations of shock and cardiovascular decompensation, a unifying theme of
traumatic shock is an overwhelming inflammatory response driven by proinflammatory
cytokines, and the downstream results of this cytokine storm including, but not limited to,
acute respiratory distress syndrome, coagulopathy, sepsis, and multiple organ dysfunction
syndrome. Treatment is primarily supportive; however, research of novel therapeutics for
traumatic shock is ongoing and promises some directions for future care.
ACUTE AND PROGRESSIVE FETAL HYPOXIA - CAUSES AND OUTCOMES
Sharvadze N., Khotsanyan K – 6th year students
Scientific leaders - Zaritskaya E.N., Kostina V.V.
Placental insufficiency (PI) - a clinical syndrome caused by morphofunctional changes in
the placenta and disorders of compensatory and adaptive mechanisms to ensure normal
fetal growth and development as well as the adaptation of the woman's body for pregnancy.
In order to identify patterns in the causes and outcomes of placental insufficiency we had
analyzed 60 birth histories. In analyzing the causes of placental insufficiency following
extragenital diseases there were identified: acute respiratory viral infection (21.67%),
extragenital herpes (41.67%), anemia (16.67%), chronic pyelonephritis (11, 67%).
Vaginitis (33.33%), endometritis (13,33%), cervical erosion (25%), inflammation of the
uterus (10%), abortion (65%), miscarriages (20%) were the most common of genital
diseases and complications of obstetric and gynecological history. Polyhydramnios (20%),
cord entanglement (18.33%), chronic placental insufficiency (15%), IUGR (8.33%),
preeclampsia (8.33%) were important during pregnancy. In the case of progressive hypoxia
(65%) in the histology of the placenta there was found the mature placenta with
compensated CPI (66.67%), with subcompensation (25.64%), dissociated maturation of
the placenta with decompensated CPI (7.69%). In the acute hypoxia (35%) the uneven
ripening villi, (47.62%), vascular necrosis of the villi, focal sclerosis (28.57%), congestion
of the villi (28.57%) was found more frequently.
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After analyzing the above figures, comparing outcomes with the expected causes of
placental insufficiency as a whole and in each individual case, have concluded that the
outcome of the pregnancy were more influenced by the possibility of compensating of the
placenta ahead of the factors contributing to placental insufficiency.
BLOOD GROUPS AND RH FACTORS AMONG 1-ST YEAR STUDENTS OF
THE AMUR SMA (2016)
Mamontov S., Lyashenko D., Aksenova A. – the 2nd year students
Scientific leaders - Ambrosieva N. P., Kostina V. V.
Blood type is inherited combination of antigens and antibodies. Two antigens A
and B can contain on the surface of red blood cells, and in the serum may be antibodies
α and β. There are four possible combinations of antibodies and antigens determine the
four blood types: if the red blood cells antigens and blood serum of two antibodies α and
β it is AB (I) blood group. If the red blood cells have antigen A and antibody of β it is β
amyloid (II) the second group of blood. If the red blood cells have antigen β, and blood
serum antibody α it is VA (III) the third group of blood. And finally, if red blood cells
have two antigens and serum no antibodies is ABO (IV) the fourth group of blood. The
purpose of the study was to investigate the predisposition to chronic diseases depending
on the blood group, and the patterns of distribution of antigen in people of different
nationalities. Research methods: Questionnaire. Survey research: Questionnaires of 205
1–st year students of ASMA. The results of the study: 1.77% of respondents – Russians,
18% - Tuva. B amyloid (II) Rh (+) is dominated and in that and other nationalities. 2.7%
of the respondents live in the Amur region. 34.2% of which b amyloid (II) Rh (+) and
18.2% VA (III) Rh (+). 3. 12% of respondents live in the Republic of Tuva, 46% of which
b amyloid (II) Rh (+) and 42% - AB (I) Rh (+). 3. 38% of girls suffer from gastro –
intestinal diseases, diseases of the musculoskeletal system and central nervous system.
53% of them – b amyloid (II) the second blood group Rh (+) with positive Rh factor. The
same disease affects 28% of boys. 57% of them – β amyloid (II) the second blood group
Rh (+) with positive Rh factor.
TULAREMIA CONTINUES TO BE POPULAR FOR THE AMUR REGION
Mamontov S. – the 2nd year student
Scientific leaders - Prof. Gordienko E. N., Kostina V. V.
Tularemia — an acute infectious natural focal disease affecting lymph nodes, skin,
sometimes eyes, throat and lungs and is accompanied by severe intoxication. The
causative agent of tularemia is an aerobic gram-negative rod-shaped bacterium
Francisella tularensis. Of interest is the variety of carriers of tularemia: blood-sucking
insects - mosquitoes, fleas. Numerous species of wild rodents, hares, birds, dogs and
others are the natural reservoir for bacteria. The disease is characterized by variety of
symptoms. Clinical presentation depends on the organ in which the infection develops.
Forms of tularemia: the bubonic form, ulcer-bubonic form, eye-bubonic form,
anginal-bubonic, form, abdominal form, pulmonary form, generalized form.
Transmission of tularemia: vector-borne, contact, aerogenic, water, alimentary.
The urgency of the problem is determined by the characteristics of the epidemic
manifestation of infection in which the causative agent is one of the most pathogenic
microorganisms.
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Territory of the Amur region endemic for tularemia. However, a characteristic of
natural foci of this infection is their low epidemiological activity, manifested rare human
cases. In this regard, the epidemiological situation on natural focal infections, including
tularemia in the Amur region remains relatively stable. The last case of the disease among
the population of Amur oblast was registered in 2007.
Diagnosis of tularemia is made by serologic reactions, skin allergic tests,
immunogenetic methods, PCR.
CLINICAL CASE OF CHURG-STRAUSS SYNDROME
Arkhipova M., Kirey U., Matylyuk O., Strekalova M., Sharvadze N., Yudina E. – the 6th
year students
Scientific leaders - Cand. Med. Sc., Assoc. Prof. Pogrebnaya M.V., Kostina V.V.
Systemic vasculitis - a heterogeneous group of diseases, their main morphological feature
is the inflammation of the vascular wall. Systemic vasculitis are among the relatively rare
diseases: 4.2 people per 100 000 population per year.
Analysis of annual reports was conducted by rheumatology department from 1995 up to
2009 and from 2008 up to 2015. Diffuse connective tissue diseases prevailed and systemic
lupus erythematosus, systemic sclerosis and dermatomyositis were in leaders. In the group
of systemic vasculitis polyarteritis nodosa, Wegener's granulomatosis, Takayasu's
syndrome, hemorrhagic vasculitis are more common.
Churg-Strauss syndrome - is an allergic inflammatory lesion of small and medium-sized
vessels, proceeding with the formation of necrotizing eosinophilic granuloma. The
syndrome is characterized by asthma, eosinophilia, neuropathy, R-signs of pulmonary
infiltrates, paranasal sinus pathology.
Patient M., 37 years old. She was admitted in the rheumatology department on the 28th of
August with complaints on reducing surface sensitivity and muscle weakness mainly in the
left arm, leg weakness, unsteadiness in walking, increasing with closed eyes, lethargy, a
feeling of lack of air. She considers herself a patient since 1999, when an allergic reaction
of immediate type by type of hives had unreasonably developed. In 2000, she was in the
neurology department in connection with the advent of aching pain in the cervical spine;
leukemoid revealed eosinophilic reaction; trichinosis had excluded. In 2003 there was a
severe expiratory dyspnea. In September 2003 Bronchial asthma, a mixed form was
diagnosed. Since 2005, Flomax and Symbicort were appointed. In 2006, worsening - a
feeling of coldness in hands, frequent headaches. The diagnosis: Vascular dystonia.
Raynaud's Syndrome. In November 2008, the neurological symptoms appeared: a feeling
of weakness in his right hand, diagnosed: Systemic vasculitis. Churg-Strauss syndrome
(eosinophilia; with damage to the lungs: asthma, eosinophilic infiltration in the lung,
double-sided encysted pleurisy; Central nervous system, peripheral nervous system: atactic
syndrome, polyneuropathy of the upper extremities; Heart: myocardial mixed genesis.
Ventricular premature beats I c. by Bigger). In 2009, the diagnosis was confirmed at the
Research Institute of Rheumatology in Moscow. In October 2009 - Gilbert's syndrome was
diagnosed. In May 2011, the patient noted shortness of breath and palpitations expressed
with little physical activity, rare flying pains in the joints. In February 2015 - deterioration:
weakness in the legs, unsteadiness during walking and standing, the state of stupefaction,
shortness of breath with little exertion. There was hospitalization in August 2016 for the
correction of the treatment.
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CLINICAL AND ANATOMICAL SPECIFICS OF SIZES OF LARGE PELVIS OF
ASMA GIRL-STUDENTS’ (1989-1992 YEARS OF BIRTH)
Mikhaylovskiy A., Barlit H. – the 1st year students
Scientific leaders – Pavlova A.E., Kostina V.V.
Clinical and anatomical specifics of sizes of large pelvis of ASMA girl-students’
(1989-1992 years of birth) depending on type of constitution. One of the most important
government’s goals is physically strong young generation’s upbringing, that is why control
of young people’s physical development is important, especially girls’ because exactly
female organism has an important mission – motherhood. After examining a lot of
literature sources we came to the conclusion, that there was insufficient information about
sizes of pelvis dependence of the constitution’s types. We conducted 90 large pelvic
measurements with simultaneous determination of the type of constitution according to M.
V. Chernoruzkiy, using Pinya’s indexes. Taking into consideration above given data in the
table we can draw the following conclusion: all types of constitution are characterized by
the predominance of the large pelvis’ normal size.
THE 40TH ANNIVERSARY OF THE DEPARTMENT OF VASCULAR SURGERY
CAEHC AR "ARCH"
Kucherenko T. – the 6-th year student
Scientific leaders – Zavaruev A.V., Kostina V.V.
One of the main achievements of the XX century is a reconstructive vascular surgery.
In November 1975, an order was issued on the organization of care for patients with
vascular disease in the Amur region. At the same time in the Amur Regional Hospital
department vascular surgery with 25 beds was opened. One of the founders was Professor
Kulik Ya.P. - Head of the Department of Hospital Surgery BSMI. The first head of
department became M.V.Sudakov. At this time, there was gradually becoming of surgery
of great arteries in the department, the venous system, surgical technique was improved.
From 1995 up to 2012 the department was headed by Yury Konovets. This
significantly expanded the range of operational benefits. By the end of the 90-th, members
of the department of hospital surgery Mazurenko A. A., Lyashko V.V., Shimko V.V.,
Sadchikova V.V., Saharyuk A.P., Anyushkin S.V., Dubrovin V.M., Kolotova
R.B.,.Tolpygin P.V, Hotchenkov M.V. worked. Intensive practical work was accompanied
by the active research activity - on the basis of department several theses were protected,
executed about 20 patents and more than 200 publications.
The Department is currently headed by the doctor of the highest category,
Cand.Med.Sc. Mazurenko A.A. The doctors Konovets Yu.A., Tolpygin P.V., Burlakov
V.N., Domke A.P., Dzhalilov R.V., Zavaruev A.V. work here. A huge contribution to the
department was made by the nursing staff - Davydova Olga - the first elder nurse;
O.V.Fedulova – nurse-anesthezist; department-nurses - Razumets E.G., Sokolova I.I.,
Menshikova M.Yu., Starsheva Yu.S.; Lysenko T.Yu.
For 40 years, the staff of department carried out more than 20 thousand operations in
cooperation with the Department of rentgensurgical methods of investigation and
treatment, anesthesiology and intensive care and a number of others. Modern technologies
are introduced in the treatment of patients with vascular pathology - hybrid operation with
multistory lesions of arteries, joint replacement aortic angioplasty and stenting of arteries
of all vascular beds, surgery for aneurysms suprarenal and descending aorta, combined
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with advanced tumors of the abdominal and thoracic cavity, minimally invasive with
pathology of the aorta, laser and radio frequency with varicose veins, embedded
technologies outpatient phlebology. Currently, there is performed more than a thousand of
planned and emergency surgeries a year. The staff of department has a number of
government incentives and rewards.
THE ANTIOXIDANT PROPERTIES OF PARIETIN
Ruder M. – the 4th year student
Scientific leaders – Dr. Med. Sc. Prof. Dorovskikh V.A., Kostina V.V.
Parietin is the drug of plant origin, it was extracted from the lichen by B.F.
Kerimov in 1982. The model of cold stress effect has been chosen to determine antioxidant
properties of parietin. The cold effect is the daily maintenance of animals in a
climatechamber Fentron 3 hours at a temperature of -15 degree bellow zero in a ventilation
chamber.
Parietin is derived of antrakhinon. It’s a yellow powder, molecularly weight 284,
melting point is 206-207 degree, not soluble in water. (V.A. Dorovskikh, 1986).
The cold effect stimulates a sharp increase in the content of the diene conjugates
both in the liver and in the lungs of experimental animals. This is especially clearly seen
in the first 14 days of the experiment. Preliminary introduction of parietin resulted in a
decrease in the content of diene conjugates in the lungs of rats.
The cold effect inhibits antioxidant system (Е.Е. Burlakova, 1975).
Improvement of the oxygen regime of the organism play an important role in
metabolic activity of erythrocytes, factors molecular allosteric regulation of oxygenation
(deoxygenation) of hemoglobin (V.А. Dorovskikh, Е.А. Borodin, 2001, 2004, 2006).
Metabolic phosphoglycerate glycolysis 2,3-diphosphoglycerate acid is an allosteric
regulator of oxygenation (deoxygenate hemoglobin М.Perutz 1965). The increase in the
content of 2,3-DFG in erythrocytes should help to deoxygenate. The cold effect exposure
significantly reduces the content in the erythrocytes of 2,3-DFG, that promotes better
oxygenation of hemoglobin in the lungs, however, at the same time severely limits impact
of oxygen, to tissues, which contributes to their hypoxia. Parietin significantly increased
the contents of 2,3-DFG in the erythrocytes of rats which were subjected to cold exposure,
which led to the increase of oxygen release in peripheral tissues and lowered the level of
tissue hypoxia.
ISLETS OF LANGERHANS OF THE PANCREAS
Chernukha D. - the 2-nd year student
Scientific leaders - Prof.Sayapina I.Yu.,Kostina V.V
The Human pancreas (Latin páncreas.) - organ of the digestive system; large gland
having exocrine and internal secretory functions. Exocrine organ function the is realized
by release of pancreatic juice containing digestive enzymes. Producing hormones, pancreas
takes an important part in the regulation of carbohydrate, fat and protein metabolism.
Between slices numerous groups of cells are interspersed that do not have excretory ducts
- pancreatic islets. Islet cells, namely alpha-cells (15-20%) and beta-cells (65-80%)
function as endocrine gland, releasing into the blood stream directly glucagon and insulin
- hormones that regulate carbohydrate metabolism. These hormones have the opposite
effect: glucagon increases so and insulin lowers blood glucose levels. If it affects the beta
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cells, diabetes is developed. Therefore, the purpose of my work is: study of the structure
and function of pancreatic islet isolation mechanism of insulin from the beta cells and the
mechanism of islet transplantation apparatus.
It is known that mature islet pancreatic parenchyma has ordered organization. It is
surrounded by connective tissue, has lobules, and the blood capillaries are inside. Islets are
made up of cells - islet cells, among which are based on the presence in them of different
physical, chemical and morphological properties of the granules there are 5 main types:
alpha cells (15-20%), beta cells (65-80%), delta cells (3-10%), PP cells (3-5%) and epsilon
cells (<1%). Islet cell architecture affect intercellular connection and paracrine regulation,
synchronizes the release of insulin. Namely, the beta cells support basal insulin levels, and
also provide a rapid release of insulin presynthesized and its formation, with a sharp
increase in blood glucose levels. Answer comes fast enough and usually takes a few
minutes. Under the influence of the stimulus - high blood glucose - beta cell membrane is
depolarized, calcium ions enter the cell that starts the process of reducing the intracellular
microtubule system and the movement of the granules to the plasma membrane with their
subsequent exocytosis. In violation depolarization of mechanisms of beta cells there is
produced antibodies that destroy them and lead to the development of diabetes.
Topical method of treatment of diabetes is the allograft cells pancreatic pancreas
islets from one human donor to another person - the recipient. Transplantation of islet
apparatus serves as a worthy alternative to transplantation of the pancreas, or installing
artificial organ. This is one of the types of experimental treatment of diabetes of first type.
An alternative source of material for the recovery of pancreatic islets are stem cells. They
may be relevant, as donor cells reserves are limited.
Thus, knowledge of the structure and function of pancreatic islets are necessary for
each qualified doctors, who are often in their practice will face diabetes disease that
develops because of the defeat of their structure. The early detection of diabetes in a patient
there is a very high chance of avoiding further development of this serious illness.
PORPHYRIN DISEASE
Seficulieva A. - the 2-nd year student
Scientific leaders - Assoc. Prof., Cand. Biol. Sc. Doroshenko G.K., Kostina V.V.
Porphyria or porphyrin disease ( Gr. Πορφύριος - "purple",) - almost always an
inherited disorder of pigment metabolism with a high content of porphyrins in the blood
and tissues and increased of their allocation with urine and feces. It is Manifested by
photodermatosis , hemolytic crises, gastrointestinal and neuro-psychiatric disorders.
It is classified in accordance with the main places of hemoglobin synthesis, which
manifest "error" of metabolism. Primary violation may occur in the liver (hepatic porphyria
(porphyria hepatica)) or in bone marrow (erythropoietic porphyria (erythropoietic
porphyria)); sometimes it can develop in both these bodies. On the clinical course of the
disease is often divided into acute porphyria shapes and forms, occurring primarily with
lesions of the skin.
Non-protein part of hemoglobin - heme is not synthesized but accumulated
intermediate products of its synthesis - porfirinogenes. They are converted into the light
porphyrins which, by interaction with atmospheric oxygen form active radicals that
damage skin cells. The skin starts to get brown hue, becoming thinner and by exposure to
sunlight they bursts, so the skin of covered with time is scars and sores. Ulcers and
inflammation damage the cartilage - the nose and ears, deforming them. Coupled with
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covered sores and twisted fingers, it's incredibly disfiguring man. Sunlight is
contraindicated to patients as it, brings them untold sufferings.
Well-known expert on porphyria David Dolphin says that. Even weak sunlight
adversely affects the patient. Skin damage can be so severe that his nose or fingers can be
completely destroyed. The lips and gums were significantly reduced while maintaining the
normal size of teeth - the result is a likeness of an animal jaw with fangs. Moreover,
reinforced hair growth can be in porphyria patients. Dolphin wrote: ... try to imagine how
in the Middle Ages perceived the one who went out into the street alone at night, and it
looked like a kind of animal - increased hairiness, large teeth, disfigured face.
It is assumed that such people might well consider were wolves. Dolphin suggests
that vampires bloodsuckers, too, were victims of porphyria and "sought to ease terrible
disease symptoms," If you drink a lot of blood, then someone else will bring the missing
hemoglobin due to impaired biosynthesis of red blood cells and alleviate the symptoms.
Although the effect of hemoglobin released into the bloodstream through the lining of the
stomach, is extremely small. Today porphyria patients are often treated by injecting the
hemoglobin.
BREAST CANCER
Pisarevsky A. - the 3-rd year student
Scientific leaders - N.V. Menshchikova, E.A. Volosenkova
The incidence of breast cancer takes the 1st place, more that 1 300 000 new cases
per year in the world are detected, 458,300 women die of breast cancer, despite the fact
that this pathology is a so-called visual location. Breast cancer is a malignant tumor of
glandular breast tissue. In the world it is the most common form of cancer among women,
affecting over a lifetime from 1/13 to 1/9 of women aged 13 to 90 years. Risk factors and
causes of breast cancer: menopause at the age of over 50 years; no delivery or first birth
over the age of 30 years; family history. Previous pathological processes in its tissues
(fibrocystic breast disease) dishormonal hyperplasia. Endocrine disorders are often caused
by associated diseases of ovaries, repeated abortions, improper feeding of the child, etc.,
anatomical and embryological abnormalities - the presence of additional lobes of glandular
tissue, and previous benign tumors - breast fibroadenoma. According to histological
structure the following breast cancers are more often: an adenocarcinoma or solid cancer
with a variety of transitional forms, alveolar, pleomorphic, tubular, mucinous, medullary.
There are ductal and lobular cancers presented by infiltrating and uninfiltrating forms.
PANCREAS TRANSPLANTATION
Prygunov V., Marushko L. - the 3rd year students
Scientific leaders – Doc.Med.Sc. G.N. Maruschenko, A.V. Sergienko, V.V.
Grebenyuk, E.A. Volosenkova
The pancreas is a complex organ with both exocrine and endocrine functions.
Disorders of the pancreas require surgical intervention. Transplantation of the pancreas
is associated with great technical difficulties. There are also biological problems caused
by high enzymatic activity of trypsin, so that a process of "self-digestion" may occur. The
most preferred mode of transplantation of pancreas is its transplantation in the peritoneal
cavity and close connection to the vascular cavity. Now the problems of transplantation
of the pancreas are studied in several directions. Along with the development of methods
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of transplantation a model of an antifical pancreas creation continues. Currently it is a
miniature device with a dispenser for insulin release into the blood, made of stainless
steel, silicone rubber or polytetrafluorethylene. It is implanted under the skin of the patient
and essentially imitates the work of the endocrine cells. Transplantation of the pancreas
is so far the least known chapter of Transplantation.
MODERN ASPECTS OF BRAIN TRANSPLANTATION
Pisarevsky A. - the 3rd year student
Scientific leaders - G.N. Marushchenko, V.V. Grebenyuk, E.A. Volosenkova
The probability to transplant the brain is investigated for a long time. Since the
beginning of the century, scientists have tried to implement various brain transplantations
by transplanting the head. The best resultswere achieved by the Soviet surgeon V.P.
Demihov. He proved fundamental possibility of such an operation and the preservation of
the viability and full activity of the transplant on the recipient's body. In the developed
model of the isolated brain transplantation donor vessels of the brain are connected with
the vessels of the recipient. Transplanted brain was placed in a cervical pocket between the
carotid artery and jugular vein. The brain is connected with monitoring systems for EEG
monitoring, temperature, cerebral blood flow velocity. The volume of cerebral blood flow
through the graft is relatively low. Due to the successful use of modern methods of
microsurgery and vascular surgery median survival of transplanted brain was 7.3 days. in
2 of 7 cases it reached 14 days.
PREVENTION OF OXIDATIVE STRESS
Marushko L., Trebukhova A. - the 3-rd year students
Scientific leaders – E.A. Litovchenko, E.A. Volosenkova
Oxidative stress is a disorder of the metabolic processes and energy, as well as the
accumulation in the body of the active agents that damage or trigger mechanism of cell
damage, resulting in various pathological processes in the body. The causes of oxidative
stress are pathogens, involution processes, stress, environment, solar active radiation, over
eating, regular drug therapy, alcohol abuse and smoking, lack of fresh air.
Prevention:
1)Bioflavonoids. They bind free radicals, preventing their further formation and
dissemination, as well as harmful effects on cells. They influence the oxidative processes
that occur in the body, reducing their intensity.
2) Antioxidants. They are an excellent prevention of very serious diseases such as
atherosclerosis, hypertension, strokes, heart attacks, cancer. Antioxidants clean vessels,
help to normalize and restore the nervous system, hearing and vision, improve memory.
3)Polyphenols. They stop the oxidation process. Polyphenols include not only flavonoids
but also tannins and anthocyanins.
ACUTE CORONARY FAILURE
Trebukhova A., Marushko L. - the 3rd year students
Scientific leaders - M.E. Ostyakova .,E.A. Volosenkova
Acute coronary failure is a pathological state which develops owing to a
vasospasm, sating a cardiac muscle with a blood. The spastic stricture can develop
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in the person both in a condition of absolute physical rest, and at the raised emotional
and exercise stresses. The main symptom of a coronary failure is the feeling of an
acute pain in the field of a breast bone which can irradiate also in the left arm, a neck,
the left ear, a scapula. Emergence of such pain has the character of periodic attacks.
Attack duration seldom exceeds 3 minutes. At emergence of an attack, the patient
instinctively tries to adopt the most optimum provision, spontaneous emergence of
sensation of fear quite often becomes perceptible. An acute coronary failure –is a
cause of death of every third elderly inhabitant of the planet. Most often development
of a coronary failure is associated with a hypertonia, and also with the inflammatory
processes affecting cardiac muscles. In certain cases the systemic vasculites, an
atherosclerosis acquired and congenital heart diseases can provoke a coronary
failure. In rare cases an acute coronary failure doesn't lead to immediate death. Often
the only chance of survival is correctly given first aid. At emergence of signs of
disturbance of work of the heart the patient must take a horizontal position on a firm
plain surface, and then to put Tabulettae Nitroglycerini under tongue. The person
with an attack should be abirritated and whenever possible without sharp movements
as it can aggravate its situation. The ambulance at emergence of signs of an acute
coronary failure needs to be called surely and immediately.
HEMORRHAGIC SHOCK
Pugacheva E., Tsyupalo V. – the 3rd year students
Scientific leaders – M. E. Ostyakova, E. A. Volosenkova
Hemorrhagic shock (GSH) is a critical condition of the body associated with acute
blood loss, resulting in a crisis of macro-circulation and microcirculation, organ
dysfunction syndrome, and multisystem failure.
From pathophysiological point of view, is a crisis of the microcirculation, its
failure to provide adequate tissue metabolism to meet the demand of tissues for oxygen
and energy products, to remove toxic products of metabolism.
4 stages are distinguished according to their severity.
Clinical features of hemorrhagic shock.
GSH is manifested with weakness, dizziness, nausea, dry mouth, darkening of the
eyes, increasing blood loss — loss of consciousness. In connection with the compensatory
redistribution of the blood, its amount is reduced in the muscles, the skin is pale with a
gray tint, the extremities are cold, wet. Reduction of renal blood flow is manifested with
decreased urine output, subsequently, with the disruption of the microcirculation in the
kidneys, with the development of ischemia, hypoxia, necrosis of the tubules. By increasing
the volume of blood loss the symptoms of respiratory failure increase: shortness of breath,
disturbance of respiratory rhythm, excitation, peripheral cyanosis.
CORRECTION OF OXIDATIVE STRESS ADAPTOGENIC HERBAL
PRODUCTS HEMORRHAGIC SHOCK
Pugacheva E., Tsyupalo V. – the 3rd year students
Scientific leaders – E.A. Litovchenko, M.D., Doc. Med. Sc., Prof. N.V. Korshunova, E.A.
Volosenkova
Oxidative stress is the failure of the antioxidant system of the organism in which
the cells are exposed to excessive levels of reactive oxygen forms and other free radicals.
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Free radicals are unstable atoms and compounds, they function as aggressive
oxidants resulting in the damage of the vital structures of the body.
Despite efficient antioxidant defense system of the organism, the level of free
radicals exceeds the capacity of antioxidant potential. Thus, there is a progressive increase
in oxidative stress. Scientists believe that phytoadaptogens decrease the level of reactive
oxygen forms and other free radicals in the body, reducing oxidative stress.
Phytoadaptogens are plants that help the body to overcome a stressful situation.
Scientists have proved that foods that contain large amounts of antioxidants are
vegetables and fruits of red, orange, yellow, green, blue and black colors. Is not important
they whether are sour or sweet. For example, the black and dark blue berries are rich in
such antioxidant as anthocyanin, orange vegetables, fruits contain a lot of carotene and the
red ones - lycopene.
Berries antioxidants are blueberries, cranberries, raspberries, cherries,
blackberries, strawberries, currants. The precise dependence of amount of nutrients from a
certain type of berries is not known, but it is believed that the strong antioxidant berry is
the one with the rich color.
Among medicinal plants strong antioxidant properties belong to green tea on the
basis of rose hips, sea buckthorn, red clover, St. John's wort, nasturtium, nettle and common
wood sorrel, bark of ash, sorrel, chamomile, eleuthero and ginseng.
BACTERIEMIC SHOCK
Pugacheva E., Tsyupalo V. – the 3rd year students
Scientific leaders – Can. Med. Sc. N. R. Levchenko, E. A. Volosenkova
Bacteriemic (toxico-infectious, endotoxin) shock is possible with peritonitis,
infections of urinary and biliary tract, pneumonia, necrotizing pancreatitis, gynecological
diseases. Most often the bacterial agents are gram-negative bacteria such as E. coli,
Klebsiella, Proteus, but gram-positive bacteria, viruses, fungi and protozoa can be
pathogenic also.
Gram-positive flora secretes exotoxins that cause proteolysis and the subsequent
formation of plastoquinone. Paralysis of the vessels and hypotension in isovolemic type
develop.
Gram-negative flora contains endotoxin that enters the blood during the
destruction of bacteria. Stimulating the adrenal medulla, it causes the release of
catecholamines and subsequent vasoconstriction.
Clinical manifestations of bacteriemic shock are hyperthermia, changes in white
and red blood, agitation, stupor or coma, hypotension and microcirculatory disturbances,
arrhythmias, hypoxaemia, oliguria, jaundice, thrombohemorrhagic syndrome.
The shock can be prevented by early treatment of purulent-inflammatory diseases,
emergency closed drainage of purulent foci, proper postoperative management.
THE LIVER CIRRHOSIS, ETIOLOGY AND PATOGENESIS
Mamedova E., Moseikina V. – the 3rd year students
Scientific leaders - Doc.Biol.Sc. A.V. Krylov, E.A. Volosenkova
Etiology of the liver cirrhosis explains morphological changes in the organ. Such
factors as alcohol, malnutrition, viral infection, interruption of a metabolism cause a
necrosis of hepatocytes. However, autoimmune reactions are the main damaging factor.
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There comes lobule collapse - loss of space, which early was occupied by a
parenchyma under the influence of intra hepatic pressure. That process originates massive,
submassive necrosis, which distributes from the center of a lobule to a portal path (bridging
port – and central necrosis). In this case the restoration of hepatic tissue is impossible.
As a result portal paths and the central veins approach, connecting tissue begins to
grow. The escaped hepatocytes or fragments of hepatic lobules regenerate and form knots
– regenerators, which сonstitute with the remains of the remained parenchyma pseudo –
lobules. Pseudo – lobules represent the parenchyma sites deprived by usual radial
orientation of trabecules to the central vein. Moreover, the central veins are not found and
portal paths are not revealed on the periphery. The centers of the regenerating parenchyma
and the expanded connective tissue bands squeeze blood vessels, especially thin - walled
hepatic veins, microcirculation is broken. Тhere is an obliteration of venous vessels. Intra
hepatic pressure increases. It is 2-5 times higher in comparison with normal venous vessels.
The speed of a portal blood - flow is slowed down, the volume blood - flow decreases to
30-70%. Connective tissue grows deep into parenchyma, connects portal paths to the
central zone of a lobule. Finally, the hepatic lobule is fragmented, portal vessels connect
to branches of a hepatic vein and form arteriovenous anastomosis (shunts). Blood from a
portal vein goes directly to system of a hepatic vein by this shunts, passing by a liver
parenchyma that sharply breaks oxygenation and nutrition of hepatic cells, that inevitably
leads to emergence of new necroses.
In conclusion, it is important to mark, that the progressing of cirrhosis goes as chain
reaction: necrosis-regeneration-reorganization of the bloodstream - parenchyma ischemia
- necrosis.
ETHICS AND DEONTOLOGY IN THE PHYSICAL CULTURE AND SPORTS
AMONG MEDICAL STUDENTS
Mamedova E., Moseikina V. – the 3rd year students
Scientific leaders - F.S. Mironov, E.A. Volosenkova
According to the FGOS-3 program of medical schools, students are taught medicine
in hospitals from the first course. Therefore, the deontological principle is extremely
relevant. It provides specific requirements for the appearance of students, clothing, sanitary
and epidemiological requirements. Moreover, teachers of physical culture keep these
requirements up too.
We have carried out the research and have found that: 95% of respondents use
indoor shoes at the physical culture classes, 87% of students consider that it is necessary
to use clothing, which are recommended by teachers, 84% think it is necessary to take
shower after the physical culture class and 45% are agree with the requirement not to let
female students to have the bright long nails . It is possible to suggest, using the results of
the research, what doctor can become a student in the future, because it is extremely
important for a doctor to follow the deontological rules.
In conclusion, it must be noted that such discipline as physical culture plays an
important role in the process of formation the correct deontological norms among students,
what might be an excellent foundation for the emergence of competent experts in any field
of medicine.
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THE ACTUAL ISSUE OF HUMAN CLONING
Moseikina V., Mamedova E. – the 3rd year students
Scientific leaders - Prof. Marushchenko G.N., Volosenkova E.А.
The urgency of human organs cloning can not be overestimated. While the
population of the Earth is rapidly aging, there are the catastrophic lack of donor organs.
Besides that fact, transplantation is technically difficult and it threatens severe
complications. The artificial organs, which are made out of inorganic materials are still
imperfect. It is significant disadvantage because to clone the organ must mean not only to
create something similar, but to enforce the functions, which are inherent to the sore organ.
We carried out the survey among patients of the "Annunciation city clinical hospital
№1” at the emergency department of cardiology, trying to identify the people’s attitude to
the issue of human cloning. Analyzed the results, we found out, that 57% of patients were
in favor of the prohibition of cloning procedures. Another 43% believed that artificial
appearance of a person was morally. 50% of patients said, that they knew cases of human
cloning. 25% of people would like to have their own clone. 28% think that it is possible to
increase the number of physically and mentally gifted people with the help of cloning and,
finally, 60% of the polled people expect the progress in medical cloning.
The issue of human cloning evokes a mixed assessment. People cloning is
potentially attractive from scientific and practical point of view. In spite of this, there are
bioethics rules on the first place, which usually do not admit the development of cloning.
Moreover, the technique of cloning has not reached yet the level, which allows to use this
method extensively. After a survey, we found out that, on the one side, generally patients
extraordinary related to the cloning. On the other side, the majority of them were waiting
for a colossal leap in the sрhere of medical cloning.
POSSIBLE STRUCTURE OF THE HUMAN HAND
Panfilov S., Semeshko M. - the 2nd year students
Scientific leaders – Can. Med. Sc. S.S. Seliverstov, E.A. Volosenkova
Hand is a treasury of all kinds of information about human organism. One can
see status of a body as well as diseases. For example:
-Red palms mean toxic damage of the liver.
-Marble print of palm means defects of autonomic nervous system (ANS).
- If skin is shelling, it means the lack of A, D vitamins.
Form of hand can tell about future defects of humans. If man has wide palms and
short fingers it means that blood-vessel system is damaged. People with little palms have
high susceptibility of ANS, their “professional” disease, are bronchial asthma, rectal
inflammation, and hypotension. People with “meaty” palms have problems with bloodvessel system they have low metabolism and hypo function of thyroid.
At present diagnosis of diseases on fingers of a hand is possible. Doctors say that
the length of fingers and distance between ring-finger and forefinger may mean low high
risk of autism, psychic diseases and depression. This rotation is an indicator of fetation.
For example:
-If ring-finger is longer that forefinger, a man can be with autism.
-Short fingers point at high resistance to negative factors.
-Forefinger is like middle finger in length and it is lower than a ring-finger, in this case
the diseases of heart and stomach are possible.
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-Forefinger is longer than ring-finger may be man has pathology of colon.
Fingers like some organs and the show their work: a thumb-lungs, forefingercolon, middle finger-heart and reproductive function, ring-finger-activity of metabolism,
and allocation of over energy, little finger-heart and small intestine.
INJURY, DISABILITY, MORTALITY DUE TO ROAD ACCIDENTS IN THE
AMUR REGION IN 2016
Rybina E, Rybina M. - The 2nd year students
Scientific leader - Prof. E. A. Vanina
Traffic accident is an event that occurred during the movement of the vehicle that
killed or injured people, damaged vehicles, facilities, goods or other property damage. The
number of traffic accidents increased by 12.5% in 2016 as compared to 2015, on the roads
of Amur region. Therefore, the theme of our research is relevant. Due to the fact that the
number of cars in the city has increased by 32.7%, the number of traffic accidents has
doubled. Main causes of accidents are a violation of the distance, the use of alcohol,
speeding, talking on mobile phone, non-use of seat belts, the use of a defective car, talking
with passengers, smoking, driving, deliberate creation of an emergency. As a result of
studying the statistics it was revealed that during 2016 the number of accidents on the first
place is the city of Blagoveshchensk (491 accident victims, injured 617 people, 50 people
died). The safest city is Svobodny (7 accident victims, injured 5 people). After analyzing
the statistics for five years, it was established that the number of traffic accidents is
increasing every year. The consequences of accidents are injure 75%, disability 20% and
mortality about 5%.
AIDS IN THE AMUR REGION
Karpova M., Semeshko M. - the 2nd year students
Scientific leaders - Assoc.Prof. L.A.Guba, E.A.Volosenkova
Causative agent of the human immunodeficiency virus(HIV) disease was found in
1983.
According to the data of early November, 2015 862cases of HIV infection were registered
in the Amur region. This year 89 new cases and last year 53 cases were revealed.
Over the entire period of observation since 1995 on the territory of the Amur region 72cases
of HIV infection were found among foreign citizens, including 5cases in 2015. In 2015,
the highest number of HIV cases was registered in Blagoveshchensk, Belogorsk, Tynda
and Svobodny and Skovorodinsky district. Most of the cases are recorded in the age group
of 20-30 years, it accounts for 72.7%
In the Amur region 130 new HIV cases were registered in 2015,35 carriers of diagnosis
have died. Amur region is characterized by instability of population, low population
density and high rates of migration, that has an effect on the development of the HIV
epidemic. The total number of cases reported from1995 to the present day makes up 882
persons.
According to experts, the most likely cause of mortality is a late appeal for medical help,
and the rejection of anti-retroviral therapy(ART).Every year the number of patients who
are registered and the number of patients with HIV infection at the stage of secondary
effects increase.
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STRUCTURE OF THE PANCREATIC GLAND. DIABETES MELLITUS OF TYPE 1
Semeshko M. - the 2nd year student
Scientific leaders - V.S.Kozlova, E.A.Volosenkova
The pancreas is covered with the capsule from which septums pars divide an organ into
lobes. In the lobes the stroma is presented by a quaggy not properly formed connecting tissue
Pancreas is alveolar and tubular in from.
It consists mainly of an exocrine tissue. A basic element of an exocrine part of PZh — an
acinus. An acinus represents a subjedinitsa of lobes of PZh and consists of the pyramidal cells
turned by an apical part to a secretory canaliculus. Secretory canaliculus of an acinus, merging
among themselves, form intralobular ducts.
The exocrine tissue of PZh consists of three types of cells:
• acinar, producing glycolytic, lipolytic and proteolytic enzymes;
• the central acinar and ductal, cosecreting the liquid containing bicarbonates;
• cell which secretes mucin.
Acinar cells — the main structural component of acinis and PZh in general. Exocrine
pancreatic cell has the form of the truncated cone. Secretes and excretes an albuminous secret
in an acinus cavity.
Endocrine part of PZh consists of islets of Langerhans. They are separated from an
acinus by layers of a connective tissue and contain 5 types of cells: A-cells, B-cells, D-cells,
D1 cells, PP-cells.
A cell-large spherical cells with an acyanotic large core and the cytoplasma containing
acidophilic granules. Hormone the glucagon splitting a glycogen and increasing the content
of Saccharum in a blood is a part of these granules.
B-cells have the cubic form, a large core dark, rich with a heterochromatin. In a cytoplasma
of V-cells the osmiofilny granules containing hormone insulin collect. Insulin regulates
synthesis of a glycogen from a glucose. At a disadvantage of production of insulin the glucose
does not turn into a glycogen, contents it in a blood increases and conditions for development
of the disease called by a diabetes mellitus are created.
D-cells - their form sometimes star-shaped with processes. In a cytoplasma of a granule
accumulate hormone somatostatin. It slows down secretion of insulin and a glucagon, reduces
production of hormones of digestive tract - Gastrinum, a secretin, an enteroglyukagon,
cholecystokinin, etc., suppresses secretion of somatotropic hormone in a pituitary body.
D1 - cells - in a cytoplasma are taped the dense argirofilny granules containing a vazoaktiyeny
intestinalny polypeptide. It possesses the expressed vasodilating action, reduces blood
pressure, oppresses secretion of the hydrochloric acid in a stomach, stimulates allocation of a
glucagon and insulin.
PP-cells — a polygonal form of an insulotsita, in a cytoplasma are taped the granules
containing a pancreatic polypeptide. The main role of a pancreatic polypeptide in an organism
— a regulation of rate and number of exocrine secretion of a pancreas and bile in a liver.
In diabetes mellitus of the1 type there is an absolute deficiency of insulin caused by
disturbance of work of the pancreas. Disability of an organism to use the glucose arriving
with a nutrition and to reserve its excess in a liver and muscles is the cause of diabets. The
unused glucose in excess quantity circulates in a blood (it is partially removed with urine)
that adversely influences all organs and tissues. As entering glucose in cells isn't enough, as
an energy source fats begin to be used. As a result. in the increased quantity toxic for an
organism and especially for brain substances , called as ketone bodies are formed , fatty,
protein and mineral metabolism is broken.
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CARDIOMYOCYTES MITOCHONDRIA AS A FACTOR OF PROGRESSION OF
HEART FAILURE
Goleva A., Mazaeva T. - the 1-st year students
Scientific leaders - E.N. Gordienko, E.A. Volosenkova
Mitochondrial dynamics is a recent topic of research in the field of cardiac
physiology. The study of mechanisms involved in the morphological changes and in the
mobility of mitochondria is legitimate since the adult cardiomyocytes possess numerous
mitochondria which occupy at least 30% of cell volume. However, structural limits exist
in the cardiomyocytes that hinder mitochondrial movements and communication between
adjacent mitochondria. Still, the proteins involved in mitochondrial fusion and fission are
highly expressed in these cells and could be involved in different processes important for
the cardiac function. For example, they are required for mitochondrial biogenesis to
synthesize new mitochondria. They are also involved in inner membrane organization and
may play a role in apoptosis. More generally, change in mitochondrial morphology can
have consequences in the functioning of the respiratory chain, in the regulation of the
mitochondrial permeability, and in the interactions with other organelles. Furthermore, the
proteins involved in fission of mitochondria are altered in cardiac pathologies such as
ischemia or heart failure. Thus, mitochondrial dynamics deserves particular attention in
cardiac research.
CERVICAL CANCER
Baldan S. – the 3rd year student
Scientific leaders – Can.Med.Sc. N.V. Menshchikova, E.A. Volosenkova
Cervical cancer is a malignant tumor that develops from the mucosal lining of
the cervix. Among malignant tumors of female genital organs, cervical cancer ranks
second after breast cancer. The cause of cervical cancer is infection with human
papillomavirus. Early pregnancy, a large number of sexual partners, sexually transmitted
disease, inflammatory processes of genital organs, smoking, and prolonged use of
hormonal contraceptives increase the risk of malignant tumors.
Cervical cancer is preceded by precancerous lesions, in the form of severe
dysplasia of the epithelium of the vaginal portion of the cervix. Cervical cancer can be
noninvasive (cancer in situ) and invasive. One can distinguish between cancer of the
vaginal portion of the cervix and cancer of the cervix. Cancer of the vaginal portion
usually has exophytic growing in the vaginal cavity, and early ulcerates. Cancer of the
cervical canal has endophytic growth. It grows through the cervix, surrounding tissue
and grows into the bladder wall and rectum. In ulceration of the tumor vaginal-vesical
or vaginal-rectal fistula are formed.
On the histological structure the cervical cancer can be squamous, glandular
(adenogenic) and glandular-squamous, and each of them may have a different degree of
differentiation. In addition, we distinguish endometrioid adenocarcinoma of the uterine
cervix.
Metastases in cancer of the cervix occur early and spread through the lymphatic
ducts to the lymph nodes of the pelvis, inguinal and retroperitoneal; later hematogenous
metastases occur.
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HYPERNEPHROMA
Osintseva A. – the 3rd year student
Scientific leaders - N.V.Menshchikova, E.A.Volosenkova
Renal cancer - a malignant tumor of the kidney, which is most often a carcinoma
and develops either of the epithelium of proximal tubules and collecting tubules (renal cell
carcinoma, RCC), or from the epithelium of the renal pelvic system (transitional cell
carcinoma). In adults, the proportion of renal cell cancer among primary malignant renal
tumors is 80-85%. According to other sources, on the renal cell carcinoma makes up for
approximately 90% of all malignant renal tumors. There are 4 types of kidney cancer: clear
cell (60-85%), chromophilic (papillary, 7-14%), chromophobe (4-10%) and cancer of the
collecting ducts (2-5%). The histological types of renal cancer have characteristic genetic
features that contribute to the difference of morphological characters, different clinical
course and response to systemic therapy. Clear cell (hypernephroma) cancer - a malignant
tumor consisting of cells with pale or eosinophilic cytoplasm, located in the small
vasculature. Predominantly solitary tumor is located in the cortex of the kidney.
Multicentric and / or bilateral lesions in sporadic cancer are less than 5%. Most clear-cell
carcinomas have a node form with clear boundaries, forming pseudocapsule, characterized
by the presence of cysts, foci of necrosis and hemorrhage, calcifications. The yellow color
is caused by a tumor rich in lipids and cholesterol. Stage of disease is the leading prognostic
factor for renal cell carcinoma. About 50% of clear cell carcinomas are detected in the 1st
and 2nd stages of the disease, and less than 5% - in the 4th stage. Invasion of perirenal
tumors or tissue ingrowth into the renal vein occurs in about 45% of cases. Often there is
a combination of hematogenous and lymph node metastases. Retrograde metastasis
through paravertebral, testicular / ovarian veins is possible. Among the clear cell
carcinomas multicystosis (5% of clear cell tumors) is distinguished. It is always I grade
carcinoma with a favorable prognosis, case progression, recurrence or metastasis has not
been described. Male to female ratio is 3: 1. The average age of patients is '51 (from 20 to
76 years). Usually the tumor is represented by a node with the presence of multiple small
and large cysts filled with serous or hemorrhagic content. Node is delimited by a dense
fibrous capsule from surrounding tissues. Tumor diameter ranges from 25 to 130 mm.
More than 20% of tumors have calcium deposits in intercystic septa, often with
ossification.
SURGICAL ABORTION, CURETTAGE OF UTERINE CAVITY
Osintseva A., Lukashova L. – the 3rd year students
Scientific leaders - G.N. Marushchenko, E.A.Volosenkova
The most common and most reliable method. Cervical canal is extended by special
tools, then the curette is introduced and abraded. This procedure is performed by a
physician, and the result is achieved and evaluated immediately in the hospital. Mechanical
treatment of the uterine wall is considered to be qualitative procedure.
On the other hand, the interference has several drawbacks. Probability of infection
is high due to the introduction of a foreign metal object through the lower genital tract
inhabited by microbes. The probability of the uterus walls injury (perforation) is rare, but
life-threatening complications may occur. The positive outcome can sometimes be
achieved by removal of the uterus only. The pregnant uterus has more friable and
vulnerable walls, especially in the place of attachment of the embryo, scraping the uterus
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is considered to be "blind" manipulation that sometimes still leads to the abandonment of
parts of the embryo and the need for re-intervention. This disadvantage can be largely
prevented by vaginal ultrasound probe to perform immediately before and after the
procedure. And you can bring it to nothing, if you do curettage under control of
hysteroscopy - inspection of the uterine cavity through a special optical system. There is a
risk of cervical injury that leads to its spasm and delay of blood clots; and in the future - to
cervical incompetence, that prevents the carrying of pregnancy, and scar deformation,
which prevents the normal process of childbirth.
The procedure is performed under general anesthesia, usually intravenous, but
sometimes - under epidural (spinal) anesthesia or general endotracheal anesthesia. Each
type of anesthesia has its own characteristics. Intravenous anesthesia is momentary
epidural-does not turn off consciousness, endotracheal - deep, fraught with complications.
The choice of anesthesia method should be determined by a physician on the totality of the
circumstances.
For the prevention of infectious complications after abortion itself a course of
antibacterial, anti-inflammatory therapy is necessary and it is obligatory from the first day,
in the early hours of physiotherapy.
PRIMARY TUBERCULOSIS
Lukashova. L. - the 3rd year student
Scientific leaders - N.V.Menshchikova, E.A.Volosenkova
Primary tuberculosis is a disease, coinciding with the period of primary infection
by mycobacteria. Children are mostly ill, but it may occur in adolescents and adults.
Morphologic expression of primary tuberculosis is the primary tuberculous complex. It
consists of three components: a lesion in an organ- the primary focus or affect, tuberculous
inflammation of efferent lymph vessels - lymphangitis and regional tubercular
inflammation, of regional lymph nodes - lymphadenitis.
Primary tuberculosis of the lungs. Children with a strong immunity recover: in the
primary affect zone petrificate - ghon`s focus is formed. It can serve as the repository of
the inactive pathogen. Progressive forms of primary tuberculosis or secondary tuberculosis
may develop over time from the ghon`s focus. Tuberculous lymphangitis is presented as
lymphostasis and formation of tubercles along the lymph vessels in the perivascular edema
tissue
In alimentary infection primary tuberculosis complex develops in the intestine.
When the disease develops nodes increase, and their contents can penetrate into the
abdominal cavity. As a result free fluid (ascites), accumulates and bloating occurs. In other
cases, the nodes are merged, causing coalescence of bowel loops. This can cause pain and
bouts of intestinal obstruction. In women the fallopian tubes and ovaries are involved in
the tubercular process. As a result of this process infertility may occur.
Similarly, primary tuberculosis complex of skin is evident. After 8-10 days,
sometimes a few weeks dense papule of red-brown color is formed, which turns into plaque
and then ulcerates .Soon regional lymphadenitis occurs, which tends to ulceration. When
healing comes only enlarged regional lymph node indicates primary tuberculosis affect.
There are three types of the course of primary tuberculosis: 1) attenuation of primary
tuberculosis and healing centers of the primary complex; 2) the progression of primary TB
with generalization of the process; 3) chronic course
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MASTOPATHY
Golub’ A., Dolgova E. - the 3rd year students
Scientific leaders – N. V. Menshchikova, E.A. Volosenkova
Mastopathy (from Greek.- mastos breast + pathos suffering, disease, synonymous fibroadenomatosis) is a dishormonal breast hyperplastic process. It occurs at the ages of 30
to 50 years.
Etiology:
• Violations of the regulatory activity of the central nervous system and the hypothalamicpituitary system, ovaries, thyroid, adrenal glands, liver.
• The consequence of certain intoxications and infections.
• Inflammation of uterine appendages and cystic changes in ovaries.
Macroscopic and microscopic picture:
Nonproliferative form of mastopathy - overgrowth of dense, often hyalinized
connective tissue in which atrophic lobules and cystic dilated ducts lined with atrophic or
light apocrinized epithelium, sometimes forming small buds are located. Dilated ducts can
be lined with pyknotic or vacuolated epithelium with sloughing of the cells and the
formation of "colostrum corpuscle"; around the ducts focal lymph plasma and cell
infiltration with a picture of mastitis is revealed.
Proliferative form of mastopathy - a combination of different variants of epithelial,
myoepithelial and fibroepithelial proliferation. In case of epithelial proliferation adenitis
or mazopathy (physiological hyperplasia of lobules with initial pathological changes) occur
with sharply increased, well-formed glandular lobules. In the later stages of mastopathy
cysts cystodenopapillomas and others are detected. In another variant of the epithelial
proliferation duct and lobular epithelium proliferation is marked. Emerging intraduct
proliferations have the form of papillae, fibrous growths and solid fields formed by
monomorphic, sometimes double-row, cylindrical epithelium with signs of secretion.
Intralobular epithelial proliferation leads to the formation of a multilayered epithelial
lining. Intraduct and lobular proliferative forms can lead to malignancy and are considered
by most authors as pre-cancerous changes.
Prognosis is favorable, with the exception of some cases, when against the
background of some forms of proliferative mastitis as a result of malignancy breast cancer
develops.
CONSERVATIVE MYOMECTOMY
Golub’ A., Dolgova E. - the 3rd year students
Scientific leaders – G. N. Marushchenko, E.A. Volosenkova
Conservative myomectomy is an organ conserving surgery carried out for women
of childbearing age.
1. Clipping and husking myoma node
In case of subserous uterine myoma node is fixed by rigid clamp, the leg of a tumor
is cut off after its pre-coagulation.
Figure 1. Myomectomy: 1 - subserous myoma node; 2 – gripping the node with
serrated clamp and cutting it off with hook of Redick; 3 - coagulation of bed of the node
with spherical electrode; 4 - removal of the preparation.
In case of subserous-interstitial localization of myoma node a circular incision is
performed. Fig.2
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Husking subserous-interstitial myoma node.
For fixing a serrated clamp or a corkscrew are used. In case of interstitial myoma
nodes incision on the uterus is performed on the highest place of the deformation of the
uterine wall with underlying node. In case of intraligamenous location of myoma node the
incision of serous uterine cover is carried out at the point of its greatest protrusion.
2. Restoration of the myometrium defects
If there is myometrium defect more than 0,5 cm in depth after myomectomy then
it must be restored using endoscopic sutures.
Figure 3
3. Extraction of macropreparation from the abdominal cavity.
a. Extraction through the anterior abdominal wall. Under visual control Museo
forcepts or Kocher clamp are introduced into the abdominal cavity, myoma node is
captured and taken out. Anterior abdominal wall is restored in layers under the control of
the laparoscope to prevent hernia or eventration.
b. Extraction through the anterior abdominal wall using morcellator. In recent years,
for the evacuation of myoma nodes from the abdomen mechanical and electromechanical
morcellators ( «Wolf», «Karl Storz», «Wisap» et al.), are used allowing them to remove
macropreparations dividing them into small parts.
at. Extraction through an incision of posterior vaginal fornix. Rear colpotomy can
be performed using special vaginal extractors. The ball of vaginal extractor is placed in the
posterior vaginal fornix, sticking it in the abdomen.
Across incision of the posterior fornix is performed between sacral and uterine
ligaments bay Laparoscopic approach using monopolar electrode. Then 10 mm notched
clamp is introduced into the abdominal cavity through trocar, myoma node is grasped and
removed from the abdominal cavity.
4. Hemostasis and sanitation of the abdominal cavity
At the end of the operation all blood clots are removed and a thorough hemostasis
of bleeding sites is performed. Adequate hemostasis and sanitation of the abdominal cavity
are prevention of adhesions in the future.
KAPOSI’S SARCOMA
Dylykova S. – the 5-th year student
Scientific leaders - O. S. Yutkina, E.A. Volosenkova
Kaposi's sarcoma (multiple idiopathic hemorrhagic sarcoma Kaposi, angiosarcoma
Kaposi, angioedema of skin) are multiple malignant lesions of the dermis, developing from
endothelium of lymph and blood vessels held in it. Often the disease is accompanied by
damage of oral mucosa and lymph nodes. Kaposi's sarcoma often manifests as, multiple
bluish-reddish spots on the skin, transforming into tumor nodules up to 5 cm in diameter.
Diagnosis of Kaposi's sarcoma includes histology of biopsy sample from the lesion, the
study of immunity and the HIV blood test. The treatment is administered by systemic and
local application of chemotherapy and interferons, radiation effects on tumor nodules,
cryotherapy.
CONGENITAL HEART DEFECTS IN CHILDREN IN THE AMUR REGION
Cherenkova M., Safarian V., Davudov T. – the 4th year students
Scientific leaders - Assoc. Prof., Doc. Med. Sc., O. A. Tanchenko, E.A. Volosenkova
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Congenital heart disease (CHD) is one of the most common congenital anomalies
in children (30% of all congenital malformations).
Inherited abnormality infections, especially viral diseases, are of great importance
in the development of defects. Identification of risk factors for having a child with CHD is
important not only from a theoretical but also practical point of view in order to predict the
risk developing and planning adequate preventive measures to reduce them.
CHD relate to multifactorial diseases because in their etiology in addition to
genetic factors a certain role is assigned to the presence in the child's parents bad habits,
keeping unhealthy lifestyle, mother’s age, toxicosis, the environment. The aim of our study
was the investigating the development of congenital heart defects in children of the Amur
region.
In conclusion, it should be noted that the risk of CHD in many cases is due to a
combination of genetic predisposition with multilateral pathological influence of internal
and external environmental factors, the simultaneity of their effects, as well as term of
exposure of the damaging factor, the number of damaging factors and the simultaneity of
their impacts.
LIVER AND ITS ROLE IN METABOLIC PROCESSES IN HEALTH AND
DISEASE
Povysheva S. – the 2-nd year student
Scientific leaders - Prof. N.P.Krasavina, E.A.Volosenkova
Liver is a vital internal organ.
Structurally functional unit of a liver is the hepatic lobe. A stroma consists of the
external connective tissue capsule, interlobular layers of RVST in which there are blood
vessels, the nervous apparatus. The liver is connected with two large blood vessels:
the hepatic artery and the portal vein.
The liver is the central organ of a chemical homeostasis of an organism.
Synthesis of proteins in a liver is carried out from free amino acids. The liver is the
only place of synthesis of albumins, a fibrinogen, prothrombin, proconvertin, proaccelerin. In chronic diseases of a liver the level of proteins in a blood can fall to very low
values that is the reason of emergence of generalized edemas and an ascites.
All metabolic processes in a liver are carried out thanks to the corresponding
enzymes which are contained in hepatocytes. In laboratory diagnostics in various diseases
of a liver biochemical indicators of a blood, such as ALT, AST, alkaline phosphatase,
GGTP have one of significances. For example, in case of alkaline phosphatase raising a
characteristic sign is an occlusion of a cholic duct. ALT may increase in viral, toxic
hepatitis, liver cancer, myocardial infarction. AST shows the maximum values at lesions
of cardiovascular system, toxic and chronic hepatitis.
Participation of liver in maintenance of concentration of a glucose in a blood is
defined by the fact that in it processes of glycogenesis, glycogenolysis, glycolysis and
gluconeogenesis proceed. For example, the increase of content of Sodium lactatum and
pyruvate in a blood can be observed also at liver parenchyma lesions (late stages of
hepatitis, cirrhosis, etc.)
Detoxication belongs to a series of the homeostatic functions of a liver. Bacteria and
other pathogenic organisms are removed from a blood of sinusoids by Kupffer’s cells, and
toxins are decontaminated as a result of the biochemical reactions occuring in hepatocytes.
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Thus, the liver is the organ taking the major part in processes of metabolism,
circulation, digestion.
MORTALITY IN THE AMUR REGION IN 2014
Alieva A., Saaya L. – the 5th year students
Scientific leaders – Can.Med.Sc. E.A.Sundukova., E.A. Volosenkova
Mortality- process of generation extinction, is one of the two major sub- processes of
population reproduction. It depends on a large number of biological and social factors
(climatic, genetic, economic, political, cultural, and others).
Total mortality of the population in the Amur region in 2014 was 13.9 per 1,000
population, in the Russian Federation – 13.1 per 1,000 population. In the structure of
mortality in the first place there are diseases of the circulatory system – (600 per 100
thousand people). In the II place – neoplasms – (182.7 per 100 thousand population),
including malignant (181.6), in the III place – cerebrovascular diseases – (138 per 100
thousand population), in the IV place – digestive diseases – (88.6 per 100 thousand
population) in the V place – respiratory diseases – (63.5 per 100 thousand population).
(Fig.1)
Infant mortality is one of the main indicators of population health. In the Amur region
in 2014, infant mortality was 9.1 per 1000 alive births. The main causes of infant mortality
are individual states of perinatal period – 56.4%, congenital anomalies – 12.9%, and
sudden death syndrome – 5%. (Fig.2)
Conclusion: Thus, the analysis of mortality of the population showed that in 2014 the
highest adult mortality was from diseases of the circulatory system, and the infant mortality
was caused by the individual states of perinatal period.
TUBERCULOSIS AND RESPIRATORY COPD
Balatsereva E., Babijchuk E. – the 6th year students
Scientific leaders - L.P. Zagnii, E.A. Volosenkova
The frequency of COPD in patients with pulmonary tuberculosis is from 12-15 to 90%
with a tendency to increase in frequency during the destructive and chronic forms. With
age, the number of patients with pulmonary tuberculosis in combination with COPD is
increasing.
Tuberculosis often joins COPD - paratuberculosis process, the two diseases can occur
in one patient at the same time - metatuberculosis process. COPD sometimes develop as a
result of tuberculosis on the background of residual changes - post-tuberculosis process.
The occurrence of non-specific inflammation in the lung tissue and bronchi in patients
with tuberculosis is associated with fibrous deformation and disorder of the drainage
function of bronchi. The non-specific inflammation is constant morphological and clinical
component of disseminated and especially fibro-cavernous and cirrhotic pulmonary
tuberculosis. The course of tuberculosis in patients with COPD is less favorable.
Chronic obstructive pulmonary disease (COPD) is a disease characterized by persistent
airflow limitation that is usually progressive and associated with an increased chronic
inflammatory response of the lungs to the action of pathogenic particles or gases.
In patients with active tuberculosis joining nonspecific inflammation may manifest as
increased cough, shortness of breath, the appearance of cyanosis. The amount of sputum
increases, a variety of pathogenic microflora is revealed.
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It is necessary to examine the sputum for the presence of nontuberculous flora and its
antibiotic resistance, to determine the function of external respiration with the assessment
of the reversibility of bronchial obstruction. Tobacco smoke affects to mycobacteria,
increasing the cases of mutations to produce antibiotic-resistant forms and activating their
metabolism and the tendency to breed.
Specific chemotherapy should be strengthened. In the appointment of broad-spectrum
antibiotics the peculiarities of their combination with the anti-TB drugs should be taken
into account.
THE IMPACT OF HUMAN PAPILLOMAVIRUS ON A WOMAN'S
REPRODUCTIVE FUNCTION
Velchenko E., Bugreeva T., Zeynalov O. - the 5th year students
Scientific leaders - Can.Med.Sc. D.S. Lysyak, E.A. Volosenkova
Human papillomavirus (HPV) is one of the most common, sexually transmitted
diseases. According to the Center for Disease Control and Prevention, currently 10 million
people are infected with the virus in our country, which exceeds the prevalence of other
sexually transmitted infections. Every year there are 5 million new cases of HPV infection.
HPV is a virus having a DNA double helix. There are over 100 different types of HPV,
only 30 of which are sexually transmitted. In many women HPV infection is asymptomatic.
Symptoms of the disease: papillomas are found on genital organs abnormalities in the Pap
smears, precancerous and cancerous formations of uterus neck, vagina, external genitals
and rectum. There are types of HPV with high and low risk of tumor development. Either
type can cause the formation of visible warts on the external genitals, but most- 6 and 11
types. Papilloma are usually asymptomatic, but can be painful, itchy and reach a size that
prevents intercourse. To determine the high-risk of HPV types a detailed test with nucleic
acid of Pap smears is used. However, papillomas are found on the external genitals not in
all of pations. High-risk HPV types (16, 18,31,33 and 35) are associated with the
development of tumors in the first place - the cervix. Definition of high-risk HPV types is
an indication for further investigation using a colposcopy and, if indicated, uterus neck
biopsy. Treatment of localized precancerous and neoplastic growths using cryotherapy,
electrosurgical excision sometimes leaves scarring that affects the mucus formations in the
cervix and can prevent fertilization. Invasive tumor of the cervix can become a cause of
loss of reproductive function. The treatment does not eliminate the virus dramatically, so
in relation to HPV infection prevention is particularly important. Recent studies have
shown that 3-fold vaccination against HPV-16 infection prevents the development of
persistent HPV type 16 and associated cervical cancer in women college-aged for 17
months after vaccination. This discovery will undoubtedly lead to further development of
a vaccine against all major types of high-risk HPV.
CONSEQUENCES OF EMERGENCY SITUATIONS AT TORNADOES IN
RUSSIA AND THE AMUR REGION FOR 2016
Podgorbunskaya E. – the 2nd year student
Scientific leaders - Can.Biol.Sc. , Assoc.Prof. L.A.Guba, E.A.Volosenkova
Tornado is the atmospheric whirlwind arising in a cumulus and rain (storm) cloud
with a diameter of tens and several hundreds meters.
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In Russia they most often happen in the central regions, the Volga region, in the Urals,
in Siberia, on the coast and in water areas of the Black, Azov, Caspian and Baltic seas.
In 2016 tornadoes were registered on May 15 in Volgodonsk, on July 13 in the Mozhaisk
and Ruza districts, on August 24 in Syktyvkar and on October 8 and 13 in Sevastopol. As
a result the set of settlements was damaged, more than 500 houses remained without
electricity, more than 200 buildings were damaged and several structures were demolished.
Owing to the tornadoes registered in the territory of the Amur region on July 16 in
Blagoveshchensk and on August 12 ,13 in the Bureya and Arkharinsky districts several
people suffered, tens of trees and pylons of the power line were demolished and more than
150 houses were damaged.
This summer in Russia a periodic emergence of "inexplicable" tornadoes was registered
in different corners of the country. Ecologists claim that a problem of global warming and
jump of climate on Earth, shifts of natural zones on the planet should be discussed urgently
at the international level, because it becomes more difficult to predict the phenomena, and
to protect people from anger of the nature is harder and harder.
SUPERVISION OF PATIENTS WITH BRONCHIAL ASTHMA AND CHRONIC
NICOTINE INTOXICATION DURING PREGNANCY
Salomatova E., Apryshkina E. - the 5th year students
Scientific leaders - Doc. Med. Sc. O.B.Prikhodko, Assoc.Prof. E.I. Smorodina,
E.A. Volosenkova.
The aim was to study the clinical features of bronchial asthma (BA) in pregnant women
with chronic nicotine intoxication. The dynamics of asthma in the course of pregnancy:
was determined in 13 (50%) - worsening with the lack of control during gestation, in 8
(30.7%) - without essential dynamics, in 5 (19.3%) - a lighter duration. The worsening of
symptoms during pregnancy were noted in patients with non-allergic and mixed forms of
moderate and severe asthma, especially who continued to smoke during gestation. In
38.4% of pregnant women there were repeated exacerbations of asthma during the
gestational period. In the structure of the identified diseases of newborns: cerebral
ischemia, intrauterine infection, impaired adaptation period, respiratory distress syndrome,
intrauterine growth retardation prevailed.
Influence of active and passive smoking on the course of asthma has been studied in
numerous works, while at the same time, taking into account the increase in the prevalence
of smoking among pregnant women, observed in recent years, the study the clinical and
functional characteristics of asthma in the gestation period in patients with chronic nicotine
intoxication, with the definition of its impact on the level of asthma control, the
development of gestational complications in fetus and newborn are of great interest. The
aim is to study the clinical features of asthma in pregnant women with chronic nicotine
intoxication.
COMPLICATIONS OF DIABETES
Kirillov I. – the 2nd year student
Scientific leaders – N.A. Feoktistova, E.A. Volosenkova
Diabetes mellitus – an endocrine disease is characterized by a chronic increase of
sugar level in blood due to absolute or relative insulin deficiency - pancreatic hormone.
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The disease leads to disruption of all types of metabolism, vascular, nervous system and
other organs and systems damages.
Retinopathy, the most serious complication of diabetes and the most common cause
of blindness, occurs in 60-80% of patients with diabetes mellitus. In the early stages basal
retinopathy develops, which manifests as hemorrhages in the retina, retinal vascular
expansion, edema, if the changes do not affect the macular, vision loss usually does not
happen. In the future proliferative retinopathy may develop, which manifests as a neoplasm
of blood vessels of the retina and vitreous. Fragility and high permeability of newly formed
blood vessels lead to frequent bleeding in the retina or vitreous. At the site of blood clots
fibrosis develops, leading to retinal detachment and blindness.
Nephropathy develops in about one third of patients with diabetes mellitus. Electron
microscopic changes of the basic membrane in the glomeruli can be found already in the
first year after making diagnosis. However in most patients clinical signs of diabetic
nephropathy appear after 10-15 years of diabetes. A sign of the early stages of nephropathy
is microalbuminuria (in the range of 30-300 mg / day), which later develops into a classic
nephrotic syndrome characterized by high proteinuria, hypoalbuminemia and edema.
Diabetic angiopathy is primarily caused by the damage of the basal vascular
membrane. At high concentrations of glucose in plasma proteoglycans, collagens,
glycoproteins are glycosylated, metabolism is disturbed and as well as correlation between
the components of the basal membranes, their structural organization is disrupted too.
Diabetic foot syndrome - a complex of anatomic and functional changes, developing
on the background of diabetic neuropathy, micro- and macroangiopathy, osteoarthropathy,
contributes to trauma and infection of the soft tissues of the foot, the development of
purulent necrotic process and in severe cases leads to amputation.
SPHINGOLIPIDOSES
Alekseenko A. - the 2nd year student
Scientific leaders - N.A.Feoktistova, E.A. Volosenkova
Sphingolipids - is a class of lipids related to derivatives of aliphatic amine alcohol.
They play an important role in cell signaling and cell recognition. Nervous tissue is
especially rich in sphingolipids. According to the structure phospholipids and
sphingolipids are similar, but a hydrophilic backbone is not represented by glycerol bug
serine. The basis of the sphingolipid is sphingosine.
There are 3 main types of sphingolipids:
1.
Ceramides - are the simplest sphingolipids. They only contain
sphingosine, connected with the fatty acid acyl residue.
2.
Sphingomyelins contain charged polar group such as phosphocholine or
phosphoethanolamine.
3.
Glycosphingolipids contain ceramide etherificated on 1-hydroxy-group
with the sugar residue. Depending on the sugar glycosphingolipids are subdivided
into cerebrosides and gangliosides.
1. Cerebrosides contain sugar residues as glucose or galactose.
2. Gangliosides contain trisaccharide, one of them is always sialic acid.
Types of diseases associated with sphingolipids:
Sphingolipidoses - are lysosomal diseases, in which degradation of
sphingomyelins is disturbed. The accumulation of lipids in tissues leads to the development
of diseases.
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Gaucher’s disease. Among the lysosomal storage diseases the most common is
Gaucher’s disease that is inherited in an autosomal recessive type. The cause of the disease
is deficiency of the enzyme of p-glucocerebrosidase. It leads to excessive accumulation of
glucocerebroside in the brain, liver, bone marrow, spleen. In Gaucher’s disease of type I
(without lesions of the nervous system) enzyme replacement therapy is conducted, patients
receive recombinant p-glucocerebrosidase. There is increase in the spleen and liver
Fabry’s disease is a rare X-linked lysosomal disease in which there is a lack of Agalactocerebrosidase. It leads to the accumulation in the body globosides
ceramidtrihexoside (globotriazilceramide). It affects the kidneys and the cardiovascular
system, increases the risk of stroke. Since 2002, for the treatment of Fabry’s disease
enzyme replacement therapy using recombinant galactocerebrosidaze is available. The
symptoms are angiokeratoma, anhidrosis, the clouding of corneas and so on.
REGENERATION OF PANCREATIC B-CELLS
Gracheva E., Shevtcova Al. - the 2nd year students
Scientific leaders - Prof. Sayapina I.Y. Volosenkova E.A.
Physiological islet cell regeneration takes place mainly by updating intracellular
organelles. The mitotic activity of the cells due to the high specialization is low. During
the whole period of life, as in any tissue, growth and constant renewal of B-cells, take place
and also their programmed death, besides the secretion of insulin can be reduced due to
voltage and depletion of B-cells. When removing 80-90% of pancreas insulin secreting
ability of the remaining cells retains in norm, for 4-5 weeks B-cells regenerate, although
hyperglycemia persists. The ability of islets to regenerate was demonstrated in several
experimental studies. G.C. Weir (1998) found B cells generated after 10 days after 90%
pancreatotomy. In patients with obesity and without diabetes the greatest mass of B-cells
is detected. In the pathology the progressive reduction in the number of B cells and the
gradual extinction of their functions by 50% occur. In connection with the islet cells ability
to regenerate the researchers of the University of Massachusetts have opened a way to run
the regeneration of pancreatic beta cells which produce insulin. However, until now
scientists did not understand how beta cells "feel" the increased need for insulin. Dr. Laura
Alonso, found that cell proliferation is related to the stress effect on endoplasmic retikullum
(ER). Thanks to it beta cells begin to proliferate actively and try to provide the body with
the necessary insulin. We need only certain conditions. "As a result, of stress ER sends cell
nucleus a chemical signal as ATF6 protein. Only mature insulin-producing beta-cells are
able to "feel" the stress and to use this mechanism to regulate insulin production ", - says
Alonso. In the light of recent discoveries it is necessary to consider not only the stress on
the beta cells, but also research of scientists to create artificial pancreas.
ALKALOIDS. WHAT IS THE MATTER?
Dudko S. - the 2nd year student
Scientific leaders - N.A.Feoktistova, E.A. Volosenkova
Alkaloids - organic substances containing nitrogen in its composition (crystalline
powder, odorless, bitter taste)
The first alkaloid discovered by scientists, was morphine. It was named in honor
of the god of sleep Morpheus. Morphine was used at first as a sedative. And in the 19th
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century xanthine, strychnine, atropine, caffeine, Konin, nicotine, cocaine were discovered.
Alkaloid was first isolated in vitro in Germany.
Alkaloids are divided into large groups:
1 - True alkaloids (atropine, nicotine, morphine)
2. Protoalkaloids. (Mescaline, adrenaline and ephedrine)
3. Polyamine alkaloids (derivatives of putrescine, spermidine and spermine).
4. Peptide alkaloids
5. Purine alkaloids (caffeine, theobromine and theophylline)
Alkaloids of aliphatic structure are contained in the southern plants.Burning
pepper contains capsaicin. It activates the blood circulation, is used in diseases of the
joints.The famous ephedrine is obtained from a plant called Ephedra. It is used for the
treatment of allergic diseases, as an activator of the brain in cases of poisoning by certain
substances.The tea contains caffeine. Caffeine stimulates the processes of excitation in the
cerebral cortex, helps to fight sleepiness, fatigue it invigorates, improves physical and
mental activity. There are also alkaloids, normalizing body temperature, inhibiting
vomiting, pain, affecting the condition of blood vessels, muscles.
There are alkaloids that are dangerous drugs and poisons.
MALFORMATIONS OF THE RECTUM AND ANUS
Mazaeva T. - the 1-st year student
Scientific leaders - A.E.Pavlova, E.A.Volosenkova
Malformations of the rectum and anus are relatively rare, in about 5-10 thousand
infants, and in girls they are less common than in boys. Usually these defects are detected
very early.
Anomalies of structure of the rectum and anus are quite diverse. We will describe
only some of the main forms.
Complete atresia. The anal atresia is the most common. It is the absence of the
anus with the normal development of the rectum. Usually there is a small depression
covered with skin, or skin fold, which directly adjoins the gut, at the site of the anus.
Complete atresia of the anus with complete atresia of the rectum are rare. The
latter due to the underdevelopment ends blindly at a greater or lesser distance from the
anus, which also remains closed. The rectum may be completely absent, in extremely rare
cases.
The anal atresia with a vaginal fistula is less common, when fistulous hole is
located immediately behind the hymen or in the depth of the vagina. This form of atresia
is much more severe because often the fistulous hole is not sufficiently wide for freely
passing of hard stools. Extremely rare congenital fistula are combined with normal
permeability of intestine and anus.
Recognition of atresia with fistula is not difficult. In case of an internal fistula, it
is possible to specify the location, determine the size of the holes and the level at which the
blind end of the intestine is located by vaginoscopy or probing.
RADIOLOGIC DIAGNOSTICS OF BREAST DISEASES
Eroputko S. – the 4th year student
Scientific leaders – Can.Med.Sc. O.A. Mazharova, E.A. Volosenkova
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Currently, radiological examination plays a leading role in diagnosis of various
pathological breast processes, in the detection of preclinical forms of diseases. The main
methods of radiologic diagnosis are X-ray and ultrasound. CT, MRI, thermography,
radionuclide method are used for special indications for solving particular problems.
Mammography is a native plain radiography. It is necessary to make pictures of both
breasts in direct and oblique projections. Additional radiographic techniques: X-ray
sighting (direct image magnification to 1.5-2 times) axillography (radiography of soft
tissue of axilla), ductography (X-ray study with the introduction of 0.5-2 ml of a watersoluble iodinated contrast agent) into the milk ducts through the nipple,
pneumocystography (puncture cyst, liquid is removed from it, the air is introduced, and
then the mammograms in direct and lateral projections are performed). Ultrasonic method
has several advantages: safety, easiness, relative simplicity and quickness of research, the
possibility of multiple repetitions. The accuracy of breast ultrasound is increased by using
Doppler ultrasound. Thermography – a remote registration from the human body surface
by means of thermal infrared radiation, reflecting the degree of bioenergetic processes in
different parts of an organ. CT is used to identify separate metastases of breast cancer and
to assess the prevalence of the local spread of the malignant process of breast. MRI is
informative with contrast enhancement of image by intravenous introduction of
paramagnetic agents. Radial methods of investigation should be carried out in the I phase
of the menstrual cycle from the 5-6 day to the 12-14 day from the beginning of the menses.
Ultrasound is performed for girls, young women, young men and men because this method
allows to differentiate glandular tissue. This method is not ionizing and allows to
differentiate clearly cystic masses. X-ray mammography is performed for women over 4045 years and in case when fat component is expressed in the mammary gland. Doppler
ultrasound is performed to clarify the blood flow in the formations and in breast tissue.
FEATURES OF PNEUMOCONIOSIS
Mirgyan M., Pchyolina K., Shpidonova R. - 4 th year students
Scientific leaders - Cand. Med. Sc. Kostrova I.V., Cand. Med. Sc. Goryacheva S.A.,
Volosenkova E.A.
A characteristic feature of the first stage of pneumoconiosis is a "mesh" in the
lung and a small formation of nodular shadows. This is somewhat reduced lung capacity.
In the second step symmetrically tissue damage, the number of nodules increases. On the
radiograph they occupy almost all the space except the tops of the lungs. Symptomatic
increases respiratory failure, there are signs of right heart dilatation.
At the third stage, the big blackout on the X-rays form a shaped "butterfly". Lymph nodes
are enlarged, increasing the risk of developing pulmonary heart attack and death.
VEGETARIANISM AS A LIFESTYLE
Zvereva S., Gayna L. –the 2nd year students
Scientific leaders - Doc. Med. Sc. Prof. E.A. Borodin, E.A. Volosenkova
Today, vegetarianism is the way of life of many people. There are different
reasons why people choose vegetarianism. It is a conscious choice, a way to change
themselves and their lives. Some people believe that it will help them to be in a good form,
someone keeps to the commandment "Do not kill!", while others stick to the moral and
spiritual principles and others blindly follow fashion.
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What is vegetarianism? Vegetarianism is a way of life, characterized, first of all,
by meals, excluding the use of any animal flesh (i.e. meat, poultry, fish).
Nowadays, there are many disputes about the benefits and dangers of
vegetarianism. Some believe that the complete rejection of meat leads to a deficiency of
essential amino acids, while others argue that the power plant products completely fill the
body's needs.
Animal and vegetable proteins are composed of the same chemical elements and
compounds, but the meat diet contains more fat and polysaturated purine compounds which
are difficult assimilated. It is believed that an excess of these substances in the internal
environment of the organism leads to acidification of the blood and is the main cause of
the accumulation of slag on the cellular level. Besides meat food involves a significant
consumption of salt, also damages the chemical balance in the body. As for the plant food,
it is, on the contrary, alkalizes blood and, along with the delivery of a number of plant
proteins introduces natural vitamins and biologically active substances into the body.
If one completely eliminates from the diet all animal products (meat, milk, eggs),
as vegans do, no vegetable protein will replace the animal one for the amino acid
composition, or by assimilation. Of course, you can try to combine two or three vegetable
products with different types of incomplete proteins to eventually get a complete one. But
imagine how much "grass" you should eat!
According to doctors, a person can give up meat, but dairy products and eggs
should be present in his diet. On the one hand, a person is not suffering from a lack of
nutrients, on the other hand he is gradually getting rid of some diseases.
PHOTOAGING OF THE SKIN AND THE FORMATION OF MELANOMAS
Gayna L. – The 2nd year student
Scientific leaders - Doc. Med. Sc. Prof. N.P.Krasavina, E.A.Volosenkova
The skin consists of three layers: the epidermis, dermis and hypodermis. In the
basal layer of the epidermis contains melanocyte that synthesize melanin, are contained.
Skin photoaging is the most common type of damage of the skin by sunlight.
The process of photoaging of the skin has a special nature and is characterized by several
clinical, histological and biochemical changes.
Modern fashionable women in the pursuit of attractiveness and beauty tend to
cover their skin with the hot sun, for a long time being in the sunlight or in the solarium so
they expose their skin to photoaging. The market of cosmetic products is quite saturated
with special substances to protect the skin from the harmful effects of UV radiation and
photoaging. However, despite the overall increase in life expectancy, the choice of a
healthy lifestyle and active leisure does not reduce the tendency of increase in cases of
photoaging of the skin, and this trend, according to experts, is becoming more apparent.
Melanoma of the skin is a malignant tumor, growing from the pigmented cells
of moles. Most often this type of skin cancer is characterized by aggressiveness and poor
prognosis. As a rule, malignant growths develops on intact skin. On the moles that exist
for a long time, melanoma of the skin is found much less frequently.
The main risk factors for developing melanoma are: nevi, presence of dysplastic
nevi, fair skin, freckles, family history, excessive exposure to ultraviolet radiation and
suntan. Ultraviolet radiation can damage DNA. Most melanomas have abnormalities in
chromosome damage makes the DNA less able to control the growth and division of cells.
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The most important way to reduce the risk of melanoma is to reduce the time
of presence under intense sunlight.
In the whole country over the last ten years (2002-2011) incidence of malignant skin
tumors had a tendency to increase (from 98.4 to 99.0 per 100 000 population). Over the
last ten years, the incidence among the female population exceeded that rate among the
male population, and average indicies for the country as a whole.
Melanoma has become the most frequent malignant neoplasm of the skin.
MODERN APPROACHES TO THE TREATMENT OF MYOCARDIAL
INFARCTION
Razuvaeva E. - the 2nd year student
Scientific leaders - Doc. Med. Sc., Prof. N.P. Krasavina, E.A. Volosenkova
Myocardium - is the main part of the wall of the heart, namely the tunica presented
by striated cardiomyocytes. The myocardium provides the rhythmic contractions of the
heart, alternating with relaxation. An obstruction to the regeneration of the myocardium is
the inability of the heart muscle cells to divide. Infarction is a pathology that requires
regeneration of the myocardium. Myocardial infarction is a heart muscle necrosis due, to
absolute or relative deficiency of its blood supply. The main cause of myocardial infarction
are atherosclerotic plaques in blood vessels of the heart. There are four stages of myocardial
infarction - ischemia, necrobiosis (damage), necrosis and scarring stage. Coronary artery
bypass surgery is quite a serious operation. It is performed under general anesthesia using
a machine for artificial circulation. Person’s veins or arteries are sewn with one end to the
aorta and the other to the coronary vessels supplying the heart. The term "stent" refers to
an operation that means to install the stent inside the artery, resulting in the mechanical
expansion of constricted portion and restoration of normal blood flow to the organ.
Treatment of myocardial infarction with human stem cells, fully renews the heart muscle
and coronary vessels, at the cellular level.
NOBEL PRIZE IN CHEMISTRY FOR 2016
Dashkova A., Razuvaeva L., Ryzij N. - the 2nd year students
Scientific leaders - Prof. E.A. Borodin, E.A. Volosenkova
The Royal Swedish Academy of Sciences has decided to award the Jean Pierre
Savage, Jamie Fraser Stoddart and Bernard Feringa Nobel Prize in Chemistry for 2016.
Nano car - molecular machine, designed by Bernard Feringa. Its characteristic features are
a ring and pin which are not connected by covalent bonds, and are held either by weak
intermolecular bonds or to the ends of the rod enormous molecules – stoppers are attached
which do not mechanically produce slip of the ring. These cycles move the chain at the
moment when an IAD occurs. The first steps towards the creation of molecular machines
were made by Jean Pierre Savage in 1983. He was able to connect the two ring-shaped
molecules in the chain - a compound called catenane. All molecules in catenanes are linked
with light mechanical linkage. This allows the molecules to move freely relative to each
other, which is a key moment for the proper work of molecular machines. In 1991, James
Fraser Stoddart succeeded in synthesizing rotaxanet a compound consisting of a molecule
of a dumbbell shape and a cyclic molecule, "worn" on it. He turned molecular ring down
a thin molecular axis and showed that the ring is able to move along the axis. Then Stoddart
managed to create a molecular model of the elevator, again on the basis of the rotaxane. It
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allows you to control the movement of the matrix between the original "floors" located at
a distance of 0,7nm apart. In 1999 Bernarzh Ferring developed molecular rotor blades,
which rotate continuously in the same direction, namely on the basis of its nano car was
obtained. Nano car consists of four motor components, which operate in pairs rotating in
opposite directions, thereby providing motion of a machine along metal surface.
STEM CELLS - THE FUTURE OF MEDICINE
Dashkova A. - the 2nd year student
Scientific leaders - Doc. Med. Sc., Prof. N.P.Krasavina, E.A. Volosenkova
The discovery of stem cells (SC) is considered one of the greatest achievements of
mankind. The term "stem cell" defines an individual cell or group of precursor cells having
the ability to self-renewal and differentiation into specialized tissues. For the first time the
term "stem cell" was coined in 1908 by Russian hematologist A. Maximov at the Congress
of Hematology Society in Berlin. At present, interest significantly increased to cord blood
as an alternative source of repopulating hematopoietic stem cells suitable for
transplantation. The use of cord blood for transplantation has several advantages compared
with other sources of hematopoietic stem cells: Collection of cord blood is a safe, easily
performed technical procedure, without threat to mother and newborn health, and it does
not require general anesthesia during the collection. Samples of cord blood, are on longterm storage in cryobanks, typed and can be directly used for transplantation. Frequency
of development and severity of "graft reaction against a host" in transplantation of
hematopoietic stem cells of cord blood is lower than in bone marrow transplantation. The
principal disadvantage of umbilical cord blood is a small amount of hematopoietic stem
cells, obtained by the collection and the impossibility of recollection. One of the first areas
of clinical application of stem cells hematology became, namely hematological
malignancies: acute leukemia, chronic myelogenous leukemia, multiple myeloma and
several others. Discoveries have been made in cardiology: D.Ortik and his team caused
damage of cardiomyocytes in mice by ligation of the left main coronary artery. The animals
were then injected bone marrow stem cells into the affected wall of the left ventricle, which
caused formation of cardiomyocytes, of endothelium and vascular smooth muscle cells.
The use of stem cells in neurology and neurosurgery. G.Streinberg from Neurosurgery
Department of the University of Stanford studied survival, migration, differentiation and
functional properties of human embryonic neural SC administered to the rats with stroke
model in three different areas of the body that differed in distance from the affected area
of the cerebral cortex. In 5 weeks after the SC introduction cell migration was observed in
the region of damage and their differentiation into neurons. The use of stem cells in
endocrinology. Spanish researchers with genetic engineering received insulin-producing
cells that were transplanted into diabetic mice. After 24 hours, the glucose content
decreased in mice to normal.
MILITARY SURGERY. THE ORGANIZATION OF SURGICAL ACTIVITIES IN
THE COMBAT
Startseva A., Aganina A. - the 2nd year students
Scientific leaders - Doc.Med.Sc., Assoc.Prof. I. V. Borozda, Doc.Med.Sc., Prof. E.A.
Vanina., E.A.Volosenkova
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Military surgery is a surgery section, which includes organization of surgical care
and treatment of wounded and sick in war. Military surgery differs from surgery for a
peaceful time by many aspects. In a mass surgical work in the war a certain amount of
assistance is used. In military surgery all is regulated. Famous Moscow Professor Yudin
said that surgery was born and gradually became isolated from the military surgery, not
Vice versa. War has always been the driving force of progress in terms of development of
warfare and in terms of the development of surgery: every war has given impetus to
surgery. The same military surgery has features that distinguish it from peace surgery. The
treatment should be carried out, including its features, it is a kind of "priority" in providing
assistance.
Stage of medical evacuation are the forces and means of medical service, located
in the path of the wounded from the battlefield to the rear for assistance.
On the battlefield, the nurse and medical orderly assist. They have in equipping a bag with
individual dressing packs, sterile bandages for abdomen, chest; burns dressings (contour),
vials of antidotes, drugs, hemostatic tourniquets.
In the BCH a paramedic works, he is also helping with the move: dresses a
transport splint or completes immobilization with the help of improvised means,
autoimmobilization.
From three battalions the wounded are evacuated to medical aid stations of the
regiment: this tripling in the number of injuried is called the flow of the wounded. MRS
also has a doctor who can perform surgical procedures.
Catastrophe Medicine is founded on the principles of military surgery. Emergency
medicine is the branch of medicine involving the development of strategy and tactics to
provide immediate assistance to a large number of victims in extreme conditions with the
acute shortage of forces and means of medical service.
It may happen in earthquakes, floods, explosions, collapses of transport.
MORPHOLOGICAL AND FUNCTIONAL CHARACTERISTICS OF B-CELLS
OF PANCREATIC ISLETS IN HEALTH AND DIABETES MELLITUS OF TYPE
I
Startseva A. - the 2nd year student
Scientific leaders - Prof. N. P. Krasavina, E.A. Volosenkova
The islets of Langerhans of the pancreas are clusters of endocrine cells that
produce hormones.
B-cells are islets anatomically and functionally separated from pancreatic exocrine tissue.
B-cells constituting 60-80% of the pool of islet cells-secrete insulin (with the
help of proteins-receptors) bring glucose inside the body cells and stimulate the synthesis
of glycogen in liver and muscles ,inhibit gluconeogenesis.
After reducing the number of these cells in the organism there is a deficiency of
insulin production, which leads to insulin-dependent diabetes.
The main cause of insulin-dependent diabetes of type 1 diabetes is the
appearance of antibodies to the own tissues of the pancreas. Immune system meant to
protect against external infectious threats begins to systematically kill the cells of this
organ. For the development of this type of disease the presence of a genetic predisposition,
is typical and often people begin to suffer from it at a young age, and even in childhood.
Lipid synthesis is insulin-dependent, and in insulin production disorder the
absorption of end products of synthesis, and intermediates is disrupted. Thus, the
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appearance of elevated amounts of ketone bodies in the urine, shows derangement of
carbohydrate and fat metabolism. This is the most important diagnostic feature in diabetes.
The proliferative activity of cells of the pancreas is extremely low, therefore
under physiological conditions renewal of the cells by intracellular regeneration occurs.
Insulin therapy fails to achieve the degree of accuracy of regulation of glycemia, which is
provided by normal islets of Langerhans. Too frequent episodes of hyperglycemia and
hence protein glycation and late complications of diabetes happen. Initial changes may be
reversible, but recurrent episodes of hyperglycemia lead to irreversible damages. Currently
promising methods of treatment of diabetes are: transplantation of islets or B-cells;
transplantation of genetically reconstructed cells; xenotransplantation; use of stem cells in
the regeneration of pancreatic cells.
BIOCHEMISTRY OF ALCOHOL DEPENDENCE
Aganina A., Startseva A. - the 2nd year students
Scientific leaders – Doc. Med. Sc. Prof. E.A. Borodin, E.A. Volosenkova
In medicine, alcoholism and drug abuse have one common name – diseases of
dependence. From a medical point of view alcoholism is a chronic, progressive disease,
caused by the influence of alcohol as a drug substance. In the process of drug or alcohol
abuse restructuring chemical processes (neurotransmitters) in the brain develops, i.e.
derangements in metabolism, transmission of impulses and the relationship of the nerve
cells occur. With long-term use of alcohol and drugs a deficiency of neurotransmitters,
threatening life of the organism may develop.
As a mechanism to compensate this phenomenon the enhanced catecholamine
synthesis and suppression of metabolic enzyme activity, primarily monoamine oxidase
(MAO) and dopamine betahydroxilase (DBH), which controls the conversion of dopamine
to norepinephrine occur. Stimulated by another intake of PAS ejection of catecholamines
and their rapid, excessive destruction are combined with compensatory increased synthesis
of these neurotransmitters. There is a rapid formation of the CA circuit. In case of
discontinuation of the drug, ie. during withdrawal, increased catecholamine release from
the depot does not happen, but their synthesis is accelerated. Due to changes in enzyme
activity in biological fluids and tissues (mainly in the brain) one of CA – dopamine
accumulates.
This process leads to the development of basic clinical signs of withdrawal
syndrome: high anxiety, tension, excitement, raising blood pressure, acceleration of heart
rate, the emergence of other autonomic disorders, sleep disorders, the emergence of
psychotic conditions, etc. These changes of neurochemical brain functions are the basis for
the formation of physical dependence on psychoactive drugs. In alcoholism and drug
addiction neurochemical changes in the brain are formed that may be a biological basis for
the formation of a depressive syndrome.
RESPIRATORY EPITHELIUM AND ITS CHANGES DURING SMOKING
Rybina E, Rybina M - The 2nd year students
Scientific leaders - Prof. I.Yu. Sayapina, E. A. Volosenkovа
The largest part of the airway is lined with multi-row ciliated columnar epithelium,
which contains a rich population of goblet-like cells and is known as the respiratory
epithelium. A number of factors, namely, chemical substances (acrolein, ammonia,
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cyanohydrogen acid, nitrogen oxides, acetone, acetaldehyde, formic acid), the
microorganisms, the temperature (ciliary activity) and dust. Have an effect on the
respiratory epithelium another important factor is smoking. Smoking is the leading cause
of cancer illness and death from this disease. It has a negative effect on the human
respiratory system. Respiratory organs are the first organs which suffer from tobacco
poisons.
At present, research has shown that when smoking 15 cigarettes a day, motor activity
of the cilia of ciliated epithelium is stopped, resulting in impaired mucociliary clearance
and a rapid colonization of the mucous membranes of the respiratory tract with bacterial
flora. When smoking goblet-like cells are found even in the terminal bronchioles, the ratio
of "ciliated: goblet-like cells" is changed to 5: 1 instead of 10: 1. It is assumed that Clara
secretory cells may be converted to goblet-like cells in the development of the
inflammatory process in the tracheobronchial tree. Ciliated cells are damaged and can not
be restored again, leaving a "bald spots" on the surface of the mucosa.
During the study of respiratory epithelium, experimental studies have shown that in young
smokers squamous metaplasia of epithelium in the respiratory tract, chronic inflammatory
infiltrates and small increases in the connective tissue of airway walls were found. In older
age groups, moreover atypical squamous metaplasia, has been identified.
Thus, smoking is a major risk factor for chronic respiratory diseases, especially for
the 80% of patients with chronic bronchitis.
HEALTH SELF –APPRAISALL AND ANALYSIS OF BEHAVIORAL RISKS OF
MEDICAL STUDENTS
Antonova I, Chirkova A. - the 5th year students, Cherednichenko O. - the 6th year student
Scientific leaders: Doc. Med. Sc. L.N. Voight, E.A. Volosenkova
250 senior students were the object of the study. An anonymous questionnaire of
98 questions was carried out. Every second respondent believes that he has good health,
every third - satisfactory, and one in five has rated his health as poor. 19.2% of respondents
noted that they are ill 3-4 times a year. Every third woman prefers to consult parents on
issues of treatment. 58, 2% of girls said that the health condition after entering the
university became worse; this index in guys remains stable. Only every fifth person goes
in for sport .64% of respondents regularly spend time in the fresh air. Most of the students
rest only from 1 to 3 hours per day (130, 52%), half of the students sleep 6-8 hours. 44%
of respondents complain of sleep disorders as pathological sleepiness. Every second
student has irregular meals. Every tenth student does not take liquid food. Every second
student said that while studying at the academy he began to smoke more. Alcohol is used
by 59.6% of respondents. Every tenth respondent believes that alcohol does not bring harm
to the body. The problem of alcohol abuse and alcoholism is interesting for every other
student. The tendency to deterioration of health indices is evident: every second respondent
(52.5%, 131 persons) noted that before entering the academy his health was better. There
is a decrease in the level of health culture in parallel with the increasing influence of
negative environmental factors as lack of exercise, smoking and alcohol consumption.
CARBOHYDRATES IN SPORTS
Bivzyuk E., Bivzyuk V. - the 2nd year students
Scientific leaders - E.V. Egorshina, E.A.Volosenkova
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Carbohydrates are the main source of energy. They are the main part of a ration
of a person. Their standard daily rate depends on weight, age and the level of exercise
stresses of a person and makes about 300-500 g. The standard daily rate of carbohydrates
of athletes can be much bigger. For example, during preparation for competitions the ration
of the famous American swimmer Michael Phelps of the general energy value of 10000
kcal a day includes about 1 kg of carbohydrates.
In bodybuilding and sports in which athletes are divided into weight categories
the use of carbohydrates is limited and is selective because pancreas insulin is developed
at sharp rising of a glucose in blood and it increases permeability of a membrane of cells
of fatty tissue and promotes penetration of glucoses into a cell. In adipocytes
dioxyacetonphosphate formed as a result of glycolysis is restored to glycerophosphate.
Acetyl-CoA formed in a cycle of tricarboxylic acids is used in synthesis of fatty acids.
Triglycerides which are formed of a glycerophosphate and fatty acids are deposited in a
fatty tissue . Therefore the "fast" carbohydrates causing sharp rising of level of glucose in
blood are not used in such sports and bodybuilding. Monosaccharum and disaccharum are
fast carbohydrates, they are contained in sweet and flour products, alcohol and energy
drinks etc. The main source of carbohydrates for such athletes are complex carbohydrates
which are slowly acquired, without causing sharp rising of a glucose in blood.
BILIFICATION AND BILIARY EXCRETION
Bivzyuk E. - the 2nd year student
Scientific leaders - Prof. N.P. Krasavina, E.A. Volosenkova
Bilification is the continuous process proceeding in the liver and a bile-excreting
organ, connected with passive and active transportation of substances in the liver, secretory
function of hepatocytes and ability of an epithelium of cholic ducts and a gall bladder to a
liquid absorption.
Hepatocytes together with fatty acids secrete bilirubin and cholesterin which can't
be filtered by kidneys, and various endogenic and exogenous substances: enzymes,
immunoglobulins, hormones, toxins, medicinal subst ances. Products of biliary secretion
(bile acids, bilirubin) are very toxic therefore there are processes of oxidation, methylation
and conjugation of these substances (bile acids with taurine and glycine, and bilirubin from
glucuroniltransferase), necessary for their inactivation, detoxicating and acquisition of
ability to be dissolved in water . Disturbance of processes of egestion of bilirubin leads to
various diseases which are characterized by existence of free bilirubin in blood.
Underdevelopment of an agranular cytoplasmic reticulum of newborns is one of the
common causes of it.
The bile-excreting organ also participates in bilification. The movement of bile in
a bile- excreting organ is caused by the secretory pressure of biliation, a difference of
pressure in its different parts and a duodenum and contractions of a smooth musculation of
cholic ducts, the gall bladder and sphincters. The gall bladder plays an important role in
the process of biliation: there is a secretion of mucus and mucin in bile, but its main
function is in concentration of bile at 7-10 times due to water absorption from bile by
epitheliocytes of the gall bladder. A deposition of normal and pathological components of
bile leads to formation of gallstones which can obstruct the bile movement. The
disturbance of bilirubin egestion may lead to its accumulation in an organism.
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GASTROENTEROPANCREATIC ENDOCRINE SYSTEM (APUD-SYSTEM)
Bivzyuk V. - the 2nd year student
Scientific leaders - Prof. N.P. Krasavina, E.A. Volosenkova
In the human body, there are specialized endocrine glands, as well as single
hormone producing cells, the totality of which is called diffuse endocrine system (APUDsystem). 18 types of enterinocytes are distributed in the epithelium of the gastrointestinal
tract (GIT) and carry out endocrine or paracrine secretion.
All endocrinocytes of stomach have a prismatic shape with low basophilic
cytoplasm, moderate plate complex and granular endoplasmic reticulum and mitochondria.
ECL-hormones (histamine) and G-cells (gastrin) induce dilation of capillaries and lowering
blood pressure, increased permeability of the capillary walls, tissue swelling, increased
gastric acid secretion, enzymes and other hormones.
In the small intestine, endocrine cells and narrow, have microvilli of irregular
shape on the apical surface and small preferably of a circular shape, electron-dense
granulares in the basal part of the cytoplasm. I- (cholecystokinin) and S- (secretin) and Kcells (gastric inhibitory polypeptide) secrete hormones that regulate behavior and act as
antidepressants, stimulate the secretion of bicarbonate and insulin, as well as regulate the
digestive and motor activity of the gastrointestinal tract.
The endocrine system of ileum and large intestine is mainly represented by L-cells
having round, electron-dense granules of medium size. Hormones of these cells
(enteroglucagon and YY peptide) slow motility and secretion of the digestive tract and
increase the secretion of insulin.
OCCUPATIONAL DISEASES, CLASSIFICATION
Dmitrieva D., Homenko K. – the 3-rd year students
Scientific leaders - Gosteva. L. Z., Volosenkova E. A.
Occupational diseases are diseases, which occur as result of the occupational hazard,
effects on the human organism. Occupational hazards are factors of the working
environment or the organization of work, which can have a detrimental effect on the
performance and health of workers. Occupational hazards may be due to the nature of the
labor process and the adverse industrial environment.
The relevance of our work is a problem in the production of disease at the present stage in
our society.
MICROBIOLOGICAL DIAGNOSIS OF CANDIDIASIS
Dmitrieva D., Homenko K. – the 3-rd year students
Scientific leaders - Bubinets O. V., Volosenkova E. A.
Candidiasis (candidiasis) is an opportunistic infectious disease of the skin, mucous
membranes and internal organs, caused by yeast fungi of the Candida genus of the
Cryptococcaceae family of the Deuteromycetes class. The main causative agent is Candida
albicans, rarely - C. tropicales, C. krusei, C. guillermondii, S. lusitaniae. Microbiological
diagnosis of candidiasis includes microscopy of pathological material, isolation of pure
cultures of fungi, conducting serological tests and putting allergy tests. In local and
systemic forms of the disease material for research is taken from affected areas - skin
flakes, scrapes from nails, mucus, pus, sputum, urine, bile, cerebrospinal fluid, stool, in
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generalized - blood, punctuates of abscesses, biopsy material from cadavers - blood from
the heart, pieces of parenchymal organs.
The relevance of our work is the problem of candidiasis at the present stage in our society.
EUTHANASIA
Homenko K., Dmitrieva D. – 3rd year students
Scientific leaders - G. N. Marushchenko, E. A. Volosenkova
Euthanasia is the practice of termination of person`s life, suffering from an incurable
disease, experiencing unbearable sufferings.
The term "euthanasia" is now used in a variety of senses: accelerating the death of
those who are experiencing severe pain; termination of the life of "extra" people (for
example, the program T-4); Care for the dying (eg, hospice); giving a person the
opportunity to die.
Euthanasia may take the following forms:
a) "mercy killing"
b) "suicide, doctor`s assisting”
c) "direct active euthanasia"
The relevance of our work is the problem of euthanasia at the present stage in our
society.
ANTIPHOSPHOLIPID SYNDROME AS THE CAUSE OF STROKE
Gubchik D., Zubkov S. - the 4th - year students
Scientific leaders - Doc.Med.Sc. V.N. Karnaukh, E.A. Volosenkova
Antiphospholipid syndrome – is an autoimmune disease, with the development of
arterial and venous thrombosis. Most APS occurs in women. APL are detected in 21% of
young patients with myocardial infarction, and in 18-46% of patients with stroke. Now the
presence of APL is considered as a risk factor for ischemic stroke. There are the following
forms of APS: 1) Primary (develops in patients who do not have an autoimmune disease);
2) Secondary (develops in the background of: a) an autoimmune disease; b) cancers; c)
medication; g) infections; e) other diseases); 3) Other variants. The pathogenesis consists
of the following units: 1) inhibition of procoagulant activity of proteins; 2) inhibition of
fibrinolysis: increase in plasminogen activator inhibitor, inhibition of factor II-dependent
fibrinolysis; 3) activation / damage of the endothelial cells: increased procoagulant activity
of endothelial cells, the enhancement of expression of tissue factor and adhesion molecules,
disorder of prostacyclin synthesis, increased synthesis of Willebrand factor, induction of
apoptosis; 4) platelet activation: increased synthesis of thromboxane and platelet
aggregation factors, aggregation and disorder of the functional activity of platelets. This
leads to an imbalance between coagulation and anticoagulation blood systems. The result
is increased blood clotting, which is accompanied by the development of thrombosis.
Laboratory criteria: 1) Thrombocytopenia; 2) The combination of thrombocytopenia with
hemolytic anemia; 3) Detection of serum antibodies to cardiolipin via standardized IPM (2
times within 6 weeks); 4) Detection of immunoglobulin G and M in the medium to high
titers; 5) Identification of lupus coagulant 2 times within 6 weeks by a standardized method
in several stages. At the moment, there is no generally accepted international standards of
treatment. It should include: 1) the prevention of recurrent thrombosis - anticoagulants of
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indirect action, antiplatelet agents; 2) correction of hyperlipidemia with statins; 3)
correction of hypertension with ACE inhibitors, b-blockers, calcium antagonists.
BREAKTHROUGH IN THE TREATMENT OF SCHIZOPHRENIA: A NEW
DRUG "TREVIKTA"
Gubchik D., Ovchinnikov P. - the 4th – year students
Scientific leaders - Can.Med.Sc. R.A. Anokhina, N.G. Brash, E.A.Volosenkova
Moscow, October 17, 2016 - The company "Janssen" pharmaceutical division
"Johnson & Johnson", announces the registration in Russia of a new drug "Trevikta"
(paliperidone palmitate of long-acting) with the mode of administration once every three
months) for the maintenance treatment of patients with schizophrenia, which can
significantly increase the interval between doses and the use of antipsychotic medication
four times a year instead of monthly, as in the application of injecting forms currently.
"Trevikta" for today is antipsychotic of the longest interval between the two uses of all
antipsychotic drugs registered in Russia, which maintains an optimal drug concentration in
patient's blood and, consequently, the lowest rate of application. "Trevikta" is administered
only to those patients whose condition was stable during therapy with the preceding
"Kseplion" (paliperidone palmitate, used to treat schizophrenia once a month). Results of
placebo of controlled study of the drug "Trevikta" showed that about 95% of the patients
are stable for more than 1 year on the background of the therapy, and median time to relapse
was 274 days. Schizophrenia is characterized by frequent hospitalizations (readmissions
share was 40%) and higher disability of patients (people with disabilities share of the total
number of schizophrenic patients is 66%) in the Russian Federation, according to recent
data. More than 60% of the burden of schizophrenia in the Russian Federation the indirect
costs make up, including loss of GDP, payments in connection with a temporary disability,
monthly payments, disability pensions. According to the Moscow Scientific Research
Institute (SRI) of psychiatry, only at the end of 2014 in the Russian Federation, the total
number of registered patients with schizophrenia was 372.1 per 100 thousand population
(total - 544 192 persons).
HIV MEDICINES: NEWS FROM THE UK
Gubchik D., Maretskiy R. - the 4th-year students
Scientific leaders - Can.Med.Sc. L.V. Kruglyakova, E.A. Volosenkova
The World Health Organization gives statistics about living in the world of 36, 7
million people diagnosed with HIV. Annually immunodeficiency virus kills more than half
a million people. About 2, 2 million people are among the newly infected. In Russia, there
are more than one million people with human immunodeficiency virus, but health care is
given only to 37% of patients who are registered in a specialized medical institution, which
is only 28% of the total number of patients. Now only a few cases of cure for HIV are
known - a few infants and three adults. Three adults (one - patient of Medical University
of Berlin, and two - Boston clinic patients) got rid of the human immunodeficiency virus
after a bone marrow transplantation. Operations were carried out for medical reasons - all
of these people had been diagnosed with brain cancer. “The Independent” reports on the
development of a drug which is in the near future will be used for the treatment of HIV.
This was done in a team of scientists from the 5 most famous UK universities - Oxford,
Cambridge and Imperial, King's and University Colleges. New therapies are already
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experienced on 50 volunteers who have been diagnosed with HIV. During the study one of
them (male of 44 years) actually cured of HIV. After the therapy the virus in his blood was
not detected. Already existing treatment regimen is not yet ready for use in a wide range
of patients diagnosed with HIV. But a professor at Imperial College Sarah Fiedler says that
in case of continuation of this research program a breakthrough in the treatment of HIV
will be in the next five years.
POST-TRAUMATIC STRESS DISORDER IN CHILDREN AND ADOLESCENTS
Gubchik D., Che A. - the 4th-year students
Scientific leaders - N.G. Brash, E.A. Volosenkova
Children are exposed to a variety of traumatic events. Each child has its own reaction
to injury. Some relatively painlessly tolerate shock, while in others post-traumatic disorder
(PTID) may develop: anxiety, depression and other behavior problems. The characteristic
symptoms of PTID according to the DSM-IV: 1) Constant feeling of re-experiencing the
traumatic event; 2) persistent and recurring unpleasant memories of the traumatic event; 3)
Ongoing discomfortable dreams about the event; 4) Action / feeling as if the event repeats;
5) Permanent avoidance of stimuli associated with the trauma, the indifference and
insensitivity; 6) Persistent symptoms of increased arousal must occur at least with two of
the following symptoms: difficulty with falling asleep or staying asleep, irritability or
anger, difficulty in concentrating, extreme vigilance, excessive response to stimuli.
Epidemiology and risk factors: the highest level of risk is determined in children and
adolescents who have experienced war, political persecution and repression, and the lowest
- among those who have suffered from a serious illness or injury. PTID can be accompanied
by other mental disorders. The level of opposition protest related disorders (OPD), and
attention deficit hyperactivity disorder (ADHD) increases in the presence of PTID
diagnosis. Depression and anxiety may also occur as a result of childhood traumatic events
and accompany PTID. For the diagnostic evaluation there exists a large number of
screening and diagnostic tools. One of them is the questionnaire "list of pediatrics
symptoms " filled with parents, it is used as a screening tool for symptoms of emotional
and behavioral disorders in the primary care environment. Treatment: cognitive-behavioral
therapy, focusing on trauma (CBT-T) is most commonly used. Validate a successful
treatment option for PTID in adults, adolescents and children is prolonged exposure
therapy. Psychotherapy child - parent was used as a method of treatment in preschool
children, survivors of traumatic events.
THE EFFECTIVENESS OF HONEYSUCKLE IN THE FLU
Gubchik D., Polivanova E. - the 4th-year students
Scientific leaders - Can.Med.Sc. R.A. Anokhina, E.A. Volosenkova
Honeysuckle is used for centuries in traditional Chinese medicine, mainly in the form
of infusion or tea. Recently, scientists have identified a molecule MIR2911 as part of this
plant, which has a direct effect on influenza virus type A. The results were published by
employees of Peking University (China) in Cell Research. Researchers have shown that
"decoction of honeysuckle is an antiviral agent of wide spectrum of action". Molecule
MIR2911 presents in honeysuckle even after drying and treatment with boiling water, a
decoction of the plant so retains its properties. Laboratory mice were given decoction of
honeysuckle, molecule MIR2911 is well distributed in organs, in particular the lungs. The
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researchers showed MIR2911 inhibits influenza A virus by acting on two specific genes,
PB2 and NS1, which play an important role in virus replication. Synthetic molecule
MIR2911 and its natural form, contained in honeysuckle, effectively protects lab animals
against infection with influenza H1N1 and other influenza viruses of type A. At the
moment, Chinese scientists successfully tested the drug in mice. This is the first case for
modern medicine, when a natural product has a direct antiviral effect. The authors draw
attention to the fact that the flu virus mutates frequently, creating strains that are not
treatable with old drugs. Therefore, the evolution of the virus maintains a high interest of
pharmacologists to creation of universal antiviral drugs. Molecule MIR2911 has such
properties. Its antiviral effect against influenza viruses H1N1, H5N1 and H7N9 has already
been proven.
EFFECT OF STARTING SPACESHIPS AND ROCKET LAUNCHERS ON THE
HUMAN BODY
Kirillov I, Orlova A. – The 2nd year students
Scientific leaders – Can. Med. Sc., Assoc. Prof. A.N. Miroshnichenko, E.A. Volosenkova
The rocket launchers use liquid or solid fuels. Liquid fuel includes two components
- an oxidant and fuel. The oxygen is used as an oxidizer, as well as nitric acid, nitrogen
tetroxide. Kerosene, unsymmetrical dimethylhydrazine (UDMH), and hydrogen are used
as a fuel. Solid propellant also consists of the oxidant and fuel, but they are a mixture of
solids.
Kerosene affects the central nervous system, irritates the mucous membranes of the
upper respiratory tract. In case of poisoning with vapours of kerosene body temperature,
blood pressure become lower, heart rate slows down. In prolonged inhalation of kerosene
vapors headache, discomfort in the throat, cough, eye and nasal cavity irritation occur.
Prolonged inhalation can cause dizziness, unsteady gait, mental stimulation.
Unsymmetrical dimethyl when exposed to the human body leads to the damage of
the immune, cardiovascular, lymphatic and central nervous systems, gastrointestinal tract,
blood, liver, skin, to the disorder of reproductive activity, the emergence of severe
congenital malformations, intrauterine fetal underdevelopment and other pathological
conditions.
Tetroxide of nitrogen (nitrogen tetroxide, amyl) has a toxic effect on the human
body. There is a general weakness, fatigue, reduced efficiency, deteriorating appetite, a
headache.
CORRECTION OF FOOD AT THERMAL IMPACT ON AN ORGANISM
Kutynkina A., Kadeneva V. – the 3rd year students
Scientific leaders - E.A.Litovchenko, Doc.Med.Sc., Prof. N.V.Korshunova , E.A.
Volosenkova
Range of change of temperatures in the Amur region is approximately from - 40C
to + 40C. Possibilities of the person on preservation of a temperature homeostasis are
limited in conditions of the environment both heating and cooling; a long tension of
temperature mechanisms promotes early development of exhaustion, immunity
oppression, development of diseases. The greatest losses of an organism happen with
release of sweat liquid, micro macrocells and vitamins. Correction of food is focused on
restoration of the lost liquid and various substances, according to the accompanying
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symptoms. Correction is possible with medicines, for completion of the lost liquid, this is
the introduction of water-salt solutions, glucose, and also vitamins. Further, adaptogens
must be included in correction. Medicines are good because, they are readily available,
grow in the territory of the Amur region, have practical lack of contraindications, and also
have low cost. For example: medicines of a rhodiola pink increase resistance of all
organism to external adverse factors of the environment: to the x-ray and ionizing radiation,
increase life expectancy and volume of work. In food it is necessary to increase amount of
the consumed liquid, not less than two liters of water and also various vitaminized drinks.
At strongly high temperatures it is useful to pass to digestible diet, to use more fruits. Food
provides our organism with nutrients which are required for it for development of energy
and maintenance of activity. Therefore following several rules in nutrition, and inclusions
in a diet of various adaptogens, it is possible to prevent development of various diseases.
HEALTH INSURANCE IN GERMANY
Plushch D., Vovk A. - the 5-th year students
Scientific leaders – Doc.Med.Sc., Prof. L.N.Voуt, E.A. Volosenkova.
Health insurance is compulsory for the whole population in Germany. Range of
medical services under the state health insurance is reflected in the Fifth Book of Social
Legislation (SGB V) and a number of restrictions are defined, which are reflected in §12
ABS. 1 SGB V). Salaried workers and employees whose income is below a certain level almost 50,000 Euros per year are automatically enrolled into one of currently around 130
public non-profit "sickness funds" at common wage rate for all members, which is paid for
with joint employer-employee contributions. Germany has a universal multi-payer system
with two main types of health insurance. Germans are offered three mandatory health
benefits, which are co-financed by employer and employee: health insurance, accident
insurance, and long-term care insurance. There are two separate types of health
insurance: public health insurance (Gesetzliche Krankenversicherung) and private
insurance (Private Krankenversicherung). Germany has a reputation for having one of the
best health care systems in the world, providing its residents with comprehensive health
insurance coverage. Approximately 85% of the population are mandatory or voluntary
members of the public health scheme while the rest have private health insurance. The
costs of the German health care system are immense and rising due to demographics as
well as medical cost inflation.
PRAXIS DISORDERS
Bazarsadueva N., Garaeva E. – the 2nd year students
Scientific leaders – A.E. Pavlova, E.A. Volosenkova
Praxis (action) is the ability to perform a sequence of movements to make targeted
actions on a plan worked out.
Apraxia - loss of skills developed in the course of individual experience of complex
targeted actions, without overt signs of central paresis or incoordination.
Ideational apraxia means a lost plan or idea of precise movements, disrupted
sequence of individual movements (for example to show how light a cigarette, he strikes
sharply cigarette on the box, then pulls out a match and holds it to his mouth). The ability
to perform complex orders (to wag his finger, and so on), is lost but they can repeat them.
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It occurs with the damage of supramarginal gyrus of the parietal lobe of the dominant
hemisphere (in right-handers - left) and it is always-bilateral.
Constructive apraxia - the correct course of actions suffers: a patient cannot add up
the figures. It occurs with the damage of the angular gyrus of the parietal lobe of the
dominant hemisphere, bilateral.
Motor apraxia - spontaneous actions are damaged, actions on the instructions and
imitation.
Spatial apraxia is a disorder of spatial relationships when performing complex
motor acts. The lesion occurs in a zone of statokinetic analyzer (at the connection of
parietal, temporal and occipital lobes). For example, the patient cannot give a horizontal
position to hand, get to the point, draw a picture, in writing makes spatial errors, failing to
correlate properly the complicated structure of letters and showing signs of a mirror
writing.
Oral apraxia is combined with afferent motor aphasia. The patient cannot find the
right corresponding sounds to pronounce, close in articulation sounds are mixed, the
process of writing is broken.
DOWN SYNDROME
Sakhnova O., Nagiev M. – the 5th-year students
Scientific leaders - Can.Med.Sc. O.S.Yutkina, E.A.Volosenkova
Down syndrome (DS or DNS), also known as trisomy 21, is a genetic disorder caused by
the presence of 47 instead of 46 normal chromosomes in the karyotype. It is typically
associated with physical growth delays, characteristic facial features, and from mild to
moderate intellectual disability.
Down syndrome is one of the most common chromosome abnormalities in humans. It
occurs in about one per 1000 babies born each year.
The parents of the affected individual are typically genetically normal. Those who have
one child with Down syndrome have about 1% risk of having a second child with the
syndrome, if both parents are found to have normal karyotypes.
Down syndrome can be identified during pregnancy by prenatal screening followed by
diagnostic testing, or after birth by direct observation and genetic testing.
The diagnosis can often be suspected based on the child's physical appearance at birth.
An analysis of the child's chromosomes is needed to confirm the diagnosis, and to
determine if a translocation is present, as this may help determine the risk of the child's
parents having further children with Down syndrome. Parents generally wish to know the
possible diagnosis once it is suspected
There is no cure for Down syndrome. Education and proper care may improve quality of
life. Life expectancy is from 50 to 60 years in the developed world with proper health
care.
DNA DIAGNOSIS OF GENETIC DISEASES
Tursunbayev Sh. – the 4th year student
Scientific leaders - Can.Med.Sc. E. N. Zaritskaya, E.A.Volosenkova
The number of monogenic diseases, which are available for molecular
diagnosis, has already exceeded 1000 and continues to grow rapidly. All new efficient
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and versatile enough methods of DNA diagnostics are created and continuously
improved.
DNA screening of aneuploidy of the fetus in the mother's blood has a
significantly higher sensitivity and specificity compared to currently used standard
combined screenings of the first and second trimesters of pregnancy. It can be carried
out already with 10-11 weeks of pregnancy, and in women who are pregnant again.
Favorable results of DNA screening can with high probability exclude aneuploidy of
the fetus in the studied chromosomes, including solution of prolongation of early
pregnancy in women with threatening and recurrent miscarriage. In identifying highrisk chromosomal abnormalities using DNA screening for the blood of the mother it is
necessary to conduct genetic counseling and performing confirmatory diagnostic
invasive procedures.
DNA analysis allows to define trisomy: T21- Down syndrome, T18- Edwards
syndrome, T13- Patau syndrome. Numerical anomalies of sex chromosomes:
Monosomy X - MX, Turner's syndrome, XXX- trisomy X, XXY- Klinefelter
syndrome, XYY. Sex of the fetus XX or XY - helps in risk stratification for X-linked
diseases such as hemophilia, Duchenne muscular dystrophy or congenital adrenal
hyperplasia.
In general, the problem of DNA diagnostics of genetic diseases, and
chromosomal, in fact, can be considered solved in principle. Its further progress may
relate not only to the increase in the number of diagnosed diseases, but also transfer of
the main gravity of research in the early postnatal period for screening newborns for
predisposition to multifactorial (polygenic) diseases such as atherosclerosis, heart
disease, diabetes, some tumors and neuropsychiatric diseases.
WORKAHOLISM
Tursunbayev Sh., Mosienko I. – the 4th year students
Scientific leaders - N.G. Brash
Workaholism has all the criteria of dependencies. People who work
continuously without weekends, holidays, who come early and leave work late, are
maniacs of work. When workaholics are deprived of the opportunity to work, it is
strongly pronounced. So, they have emotional liability with a predominance of
dysphoria, in other words, they feel lost. They also become evil and dismal without
any reasons. Like alcoholics, workaholics kick over the traces to the last, denying the
existing problems of dependency they have. A hard-working man has a goal, the result
of his work is very important. The professional activity is just a part of his life. It is a
way of self-expression and a method of self-dependence and wealth creation. But for
workaholic, it doesn’t. The result of the work doesn’t make sense; work is a way of
pastime for him. He focuses on the work activity. Workaholic considers that family
relationships and the family itself are interference, which distracts from a work and it
causes irritation and frustration. «The debt tyranny» of workaholic is instead «sense of
duty» of a hard-working person. A specific feature of workaholics is the «daltonism of
necessity». This daltonism prevents them to distinguish life values, normal human
needs, its implementation and satisfaction, as the healthy man does. For this reason,
productive life goes past. Workaholics recognize the value of health and the need to
stay healthy only in words, but really doing nothing for this.
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It is said that «workaholics live to work, but hard-working people work to
live». Workaholism can be considered as one of the forms of psychasthenia (OCN).
The working process only creates the impression of solution of some internal mental
problems, but really it doesn’t solve anything.
HYDRONEPHROSIS
Tursunbayev Sh., Mosienko I. – the 4th year students
Scientific leaders - Can.Med.Sc. D.N. Velichko, E.A.Volosenkova
Hydronephrosis develops as a result of disorders of the outflow of urine and is
characterized by the expansion of the renal pelvis - calice system, pathological changes
in the interstitial tissue of the kidney and atrophy of its parenchyma.
Causes of congenital hydronephrosis are destinesia of urinary tract; congenital
anomaly of location of the renal artery and others Causes of acquired hydronephrosis
are some urological diseases: urolithiasis, inflammatory changes of the urinary system,
traumatic constrictions of the urinary tract, tumors, etc. Hydronephrosis is aseptic and
infected. In the first case, the renal changes depend on the degree of obstruction and
disease duration, in the second, on the degree of obstruction and duration of disease,
and the virulence of the infection.
Hydronephrosis is manifested by pain in the lumbar region. Pain are in the
nature of renal colic with typical localization and irradiation in the course of the ureter
to the groin, scrotum in men and vulva in women, the thigh or crotch. The main
symptom of hydronephrosis is hematuria. The increase in temperature during the
amplification of pain in the lumbar region shows the accession of infection. A more
informative method of research in hydronephrosis is chromoscopy.
Treatment of hydronephrosis is surgery. It is important to do it in the early
period, when eliminating obstruction of the urinary tract, not only prevents further
anatomical changes but also leads to improved renal function.
CREATINE
Tursunbayev Sh., Mosienko I. – the 4th year students
Scientific leaders - Can.Med.Sc. R.A. Anokhina, E.A.Volosenkova
Creatine is a natural substance found in muscles of humans and animals and is
required for energy metabolism and motion. In the human body there are about 100 140 g of the substance serving as the energy source for the muscles. Daily consumption
of creatine in normal conditions is approximately 2 g. Creatine is as important to life
as protein, carbohydrates, fats, vitamins and minerals. Creatine can be synthesized by
the body from 3 amino acids: glycine, arginine and methionine. These amino acids are
components of protein.
In humans the enzymes involved in the synthesis of creatine, are localized in
the liver, pancreas and kidneys. Creatine can be produced in any of these organs, and
then transported by blood to muscles. Approximately 95% of the total pool of creatine
is stored in skeletal tissue muscles.
With the increase in physical activity, consumption of creatine also increases,
and the stock needs to be replenished through diet or by its own natural production by
the body.
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SHÖNLEIN (-HENOCH)'S DISEASE
Shalagina E. – the 5-th year student
Scientific leaders - O. S. Yutkina, E.A. Volosenkova
Hemorrhagic vasculitis (Shönlein (-Henoch)'s disease, allergic purpura, purpura
rheumatica) is a system aseptic inflammation of vessels of the microcirculatory blood
stream mainly affecting the skin, joints, gastrointestinal tract and kidney balls. Today
hemorrhagic vasculitis is the most common, haemorrhagic disease. Essentially it is an
allergic vasculitis of the superficial nature with a damage of small arterioles and venules,
and capillaries. In the International classification of diseases hemorrhagic vasculitis is
noted as allergic purple. Diagnostics of a hemorrhagic vasculitis is based on clinical
symptoms, laboratory data (blood test, urine and electrocoagulation), the study of the
digestive tract and kidneys. The basis of treatment of hemorrhagic vasculitis is therapy by
anticoagulants (heparin). In hard cases extracorporal haemocorrection, glucocorticoid
therapy, anti-inflammatory and cytostatic treatment are applied.
GILBERT'S SYNDROME
Shalagina E., Sozonova Y. – the 5-th year students
Scientific leaders – I. P. Soluyanova, E.A. Volosenkova
Gilbert's syndrome is a genetically caused disorder of bilirubin metabolism that
occurs due to a defect of the liver microsomal enzymes and leads to the development of
benign unconjugated increase of bilirubin.
The main clinical symptom of Gilbert's syndrome is jaundice. Single or multiple
xanthelasma of eyelids, the sense of heaviness in the right hypochondrium, the sense of
discomfort in the abdomen, asthenovegetative disorders, dyspepsia may occur.
An ultrasound can detect a slight hepatomegaly due to the right lobe. Sizes of spleen
are usually not changed, small splenomegaly is rarely detected. In the study of motor
function of the gallbladder its dysfunction is often determined. During the morphological
examination by light microscopy pathological changes in the liver are not detected except
lipofuscinosis.
For the diagnosis of Gilbert's syndrome, there are many functional tests
(hypocaloric, rifampicinum, with nicotinic acid, phenobarbital). The leading role is played
by molecular diagnostics: Analysis of DNA of the gene responsible for the disease
symptoms.
No specific treatment exists. Patients should follow the diet (eliminate fatty meats,
fresh muffins, bacon, sorrel, ice cream, black coffee); eliminate heavy physical exertion;
taking certain medications: antibiotics, anabolic steroids, alcohol and smoking. If the
jaundice occurs: drugs of barbiturates; cholagogues; hepatoprotetors; choleretics;
phototherapy; digestive enzymes are prescribed
THE ANALYSIS OF THE FREQUENCY OF DISEASES OF THE
CARDIOVASCULAR SYSTEM AND MORTALITY FROM THIS DISEASE
Sozonova Ya., Shalagina E. – the 5-th year students
Scientific leaders – O.A. Agarkova, Yu.V. Kvasnikova, E.A. Sundukova, E.A.
Volosenkova
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Diseases of the circulatory system are considered to be a significant medical and
social problem due a high invalidization and mortality of the population. In our country
about 1 million people die annually from diseases of the circulatory system . Mortality
from cardiovascular diseases is about 50% of the total mortality. In recent years, the
Russian Federation and Amur region have tendency to reduce morbidity and mortality from
this disease. It is connected with the fact that at present the system of organization of
medical care to patients with cardiovascular diseases is improved. There is regional
vascular centre and three primary vascular departments equipped with modern diagnostic
and medical equipment, training medical personnel has been conducted to use modern
technologies of rendering of medical aid.
MUSCULAR DYSTROPHY OF DUCHENNE-BECKER
Sozonova Y. – the 5-th year student
Scientific leaders - O. S. Yutkina, E.A. Volosenkova
Muscular dystrophy of Duchenne-Becker - is a hereditary disease of the
musculoskeletal system, characterized by progressive degenerative changes in the
musculature without primary motor neuron pathology.
Genetically a single form of muscular dystrophy of Duchenne-Becker is clinically
divided into Duchenne muscular dystrophy and Becker muscular dystrophy.
Becker muscular dystrophy benign form is explained by the fact that unlike the
Duchenne muscular dystrophy synthesis of dystrophin is determined, but either the protein
is produced in low of quantity or abnormal dystrophin is produced.
Diagnostics. Doctors suspect muscular dystrophy when progressive muscle
weakness develops the concentration of creatine kinase in the blood increases.
Also muscle biopsy is appointed - through the microscope, usually dead tissue and
abnormally large muscle fibers are visible. In the late stages of muscular dystrophy, the
dead muscle tissue is replaced by fat and other tissues. The diagnosis of Duchenne
muscular dystrophy is considered established if special tests show extremely low levels of
dystrophin protein in muscle.
Treatment. This syndrome is incurable. Physical therapy and exercise help to
prevent shortening of muscles around joints. Sometimes surgery is needed to lengthen the
tendon painful muscles. Doctors use corticosteroid Prednisolone as a mean of temporarily
reducing muscle weakness. The research phase also includes gene therapy, as a result of
which the muscles could start to produce dystrophin.
SHERSHEVSKY-TURNER’S SYNDROME
Antonosyan T. – the 5-th year student
Scientific leaders - O. S. Yutkina, E.A. Volosenkova
Shershevsky-Turner's syndrome is the chromosomal pathology caused by partial or
complete X-monosomy. Low stature, a hypogonadism, malformations (CHD, a horseshoe
kidney, strabismus, etc.), lymphostasis, deformation of joints, wing-shaped folds of skin
on a neck, etc. are clinical signs of a syndrome of Shershevsky-Turner. Characteristic
clinical features, data of researches of sexual chromatin and karyotype serve as decisive
arguments in diagnosis of a syndrome of Shershevsky-Turner. Prenatal diagnosis of
pathology in a fetus is possible. Patients with Shershevsky-Turner's syndrome need
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hormonal therapy (growth hormone, sex hormones), correction of congenital
malformations and aesthetic defects.
AUTISM IN CHILDREN
Galaktionovа S, Fomina V. - the 6-th year students, Zhevnova T.V.- resident
Scientific leaders - M.I. Bugrova, E.A Volosenkova
Autism is a common developmental disorder with the highest deficit of the scope of
communication and emotions. The most common diagnosis is 3-5 years. Only in mild cases
autism is first observed in adolescents and adults.
Signs of autism in children: disorder of social behavior, of communication,
stereotypical behavior, impaired social interaction, missing or sharply broken contact "eyeto-eye". Poor facial expressions which are often not adequate to the situation. Autistic
person usually has mask-like face, with occasional grimaces.
Gestures are used only to show the needs. Such persons are not able to understand the
emotions of others. There is a lack of interest in peers, severe speech delay or its lack
(mutism). Most children with autism have mild to moderate mental retardation. In milder
forms of the disease and the dynamic development of speech, intelligence may be normal
or even above average. The main feature of autism is the selective intelligence.
Diagnosis of autism. The first symptoms of autism parents notice. Testing with
specific questionnaires: ADI-R, CARS, ABC, ATEC,CHAT. Instrumental methods: NSG,
EEG. Hearing Test in audiologist
Conditions that imitate autism. Attention deficit and hyperactivity are often taken for
the autistic symptoms (ADH). The main symptoms of attention deficit: restlessness,
difficulties in school studies. Hearing loss - hearing loss of varying degrees; Schizophrenia,
unlike autism, starts at a later age. Symptoms develop gradually. Parents notice oddities in
the behavior of the child: the fears, obsessions, withdrawal, self-talk. Later delusions and
hallucinations, join.
ORGANIZATION OF EARLY DETECTION
CHILDREN
Fomina V. Galaktionova S.- the 6-th year student
Scientific leaders - O.A Karakulova, E.A Volosenkova
OF
TUBERCULOSIS
IN
With a view to the early detection of tuberculosis in children tuberculosis diagnostics
is performed for vaccinated against tuberculosis children from 12 months of age and up to
the age of 18 years. Mantoux is put once a year, regardless of the result of the previous
tests.
Annual coverage Mantoux children up to 14 years inclusive shall be at least 95%.
Compulsory examined children from socially disadvantaged families and living on the
territory of the Russian Federation, the children of foreign citizens, who arrived from
troubled countries on tuberculosis.
Mantoux test is carried out 2 times a year for:
- Children not vaccinated against tuberculosis for medical contraindications, and are not
vaccinated against tuberculosis because of the refusal of parents on the child's
immunization until the child vaccination against tuberculosis;
- Children with chronic non-specific diseases of the respiratory system, gastrointestinal
tract, diabetes mellitus;
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- Children receiving corticosteroids, radiation and cytotoxic therapy;
- HIV-infected children.
Within 6 days from the time of Mantoux tests the following categories of children are
sent for consultation to the TB hospital in the community:
- With newly diagnosed positive reaction (papule 5 mm or more), not related to a previous
immunization against tuberculosis;
- With long-lasting (4 years) reaction (with infiltrate 12 mm or more);
- With increase of sensitivity to tuberculin in tuberculin positive children - increased
infiltration by 6 mm or more;
- With an increase of less than 6 mm, but the size of the infiltrate is 12 mm or more;
- Overreaction to the tuberculin - infiltration is 17 mm or more;
- In case of vesicular, necrotic reaction and lymphangitis.
COURSE FEATURES OF PARATYPHOID C IN CHILDREN
Fomina V. - the 6-th year student
Scientific leader - P.K Soldatkin, E.A Volosenkova
In paratyphoid C colon is affected, destructive changes in the lymphatic intestinal
apparatus are less pronounced. Changes in the liver, spleen, bone marrow, are less
pronounced.
Typhus – like variants: fever, chills, headache, muscle and joint pain. Further
weakness develops, possibly dimming of consciousness, delirium, are possible. The skin
is jaundiced, there is roseolous, rarely petechial rash. In young children, some symptoms
are not expressed or absent. In children of the first 3 years of life paratyphoid is milder than
in adults, but often complications such as pneumonia, occur.
Gastroenteric variant of disease is accompanied by symptoms of poisoning. Stools
are fluid, abundant, have a pungent smell, can often mark the presence of muddy mucus
green content like "marsh mud." In children, especially young children, against this
background, dehydration is developing. Often paratyphoid C in children takes place in the
form of severe gastroenteritis, sometimes it looks like dysentery.
Septic paratyphoid variant C is more common in mixed infection (mixed infection)
in children with reduced immunity, runs very hard: remitting fever (fluctuations within 1,52 ° C, but not reduced to the normal range), a serious condition, rash, purulent lesions in
various organs (parenchymal hepatitis, purulent meningitis, osteomyelitis, etc.).
Diagnosis: clinical and epidemiological data (the patient from the source), are
confirmed by bacteriology study, agglutination reaction.
Treatment: hospitalization is absolute. Antibacterial (chloramphenicol, ampicillin,
etc.), detoxification (Ringers solution, 5% glucose) Plasma substitutes and (hemodes, is
polydesis, reopolyglukin), desensitizing drugs, symptomatic drugs, hormones are
indicated. Discharge must be not earlier than on the 21-23-day of temperature
normalization after two negative bacteriological examination of feces and urine and single
- duodenal contents. Pragnasis is favorable.
HISTORY OF THE DEPARTMENT OF INFECTIOUS DISEASES WITH
EPIDEMIOLOGY AND DERMATOVENEROLOGY
Galaktionova S. - the 6-th year student
Scientific leaders - P.K Soldatkin, E.A Volosenkova
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The first base of the department was 120 - bed Hospital for Infectious Diseases,
which was in a specially adapted for it 2-stored building. Currently, the department
of infectious diseases with epidemiology and dermatovenereology is based in ARIH
consisting of 5 departments: department of diagnostics, hepatic, intestinal infections
in children, respiratory infections with beds for patients with HIV infection or AIDS
related infections and intensive care unit, anaesthesiology and intensive care. The
reception ward has the relevant boxes.
Paraclinical service includes: clinical, bacteriological biochemical,
immunological, serological laboratory - PCR and HIV diagnosis, there is a X-ray
room, laboratory for the diagnosis of viral hepatitis.
The main base of the department has 6 classrooms, rooms of the head of the
department, professor, associate professors, and 2 laboratories. In general, clinic
equipment allows to conduct classes at a high level.
CORONAROGRAPHY- THE GOLD STANDARD IN DIAGNOSTICS OF
CORONARY HEART DISEASE
Alexandrova E., Naydanova D. – the 4 th year students
Scientific leaders - Assoc. Prof., O. A. Tanchenko, E.A.Volosenkova
Coronarography –an x-ray contrast method of studying a coronary artery of the heart for
diagnostics of coronary heart disease. The research allows to define the place and extent of
narrowing a coronary artery. This research is conducted on an angiographic complex of
Phillips-Integris-2000, allowing to carry out any kinds of endovascular interventions.
Today there are the following types of a coronarography: intervention coronarography; a
computer tomography – a coronarography; ultrasonic coronarography.
The coronarography purpose – is to reveal narrowing or an occlusion of coronary vessels.
The research allows to see the left and right coronary arteries departing from an aorta.
Coronarography scopes: heart surgery, therapy, cardiology.
Indications to a coronarography are: stenocardia with clinical manifestations, a state after
a myocardial infarction; asymptomatic form of coronary heart disease; heart failure;
atypical pains behind a breast bone; for the solution of a question of need of coronary
shunting; during a preparation for surgery at heart diseases; for assessment of efficiency of
drug and surgical treatment of heart troubles and an aorta. A coronarography in the
following cases is vital: the first 6 hours from the moment of emergence of pains in case
of an acute myocardial infarction; unstable stenocardia tolerant to medicinal therapy.
It is interesting to notice that absolute contraindications to carrying out a coronarography
don't exist, but there are relative: uncontrollable arterial hypertonia, acute period of a
stroke, internal bleedings (gastric, pulmonary), infectious diseases, non-compensated
diabetes mellitus, feverish state, serious renal failure, intolerance of contrast agents,
disturbance of coagulability of a blood.
Thus, a coronarography – the most informative and exact research of heart vessels, besides
it is rather safe. When keeping all references of the doctor the risk of development of
serious complications doesn't exceed 0,2%.
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OCCURRENCE OF TICK-BORNE ENCEPHALITIS AND TICK-BORNE
BORRELIOSIS IN THE RUSSIAN FEDERATION AND THE AMUR REGION
FOR 2010-2015
Semdyankina Y. - 5th year student
Scientific leaders - A.V. Gavrilov., E.A. Volosenkova.
The unfavorable epidemiological situation on infections transmitted by ticks, in
the Russian Federation and the Amur region is associated with high numbers of ticks, their
infection with virus, lack of immunization of the population in endemic areas. Annual
dynamics of morbidity is characterized by a pronounced seasonality associated with the
period of carriers activity.
In order to prevent sucking ticks it is necessary to carry out preventive measures:
quality clearing and landscaping, anti-tick-borne processing and deratization activities. As
a kind of prophylaxis persons traveling to endemic areas for tick-borne encephalitis must
be vaccinated against tick-borne encephalitis.
Thus, we can draw the following conclusion: the incidence of infections
transmitted by ticks remains at a high level. The high incidence of tick-borne encephalitis
is due to the fact that a greater number of cases of this pathology are the people who are
not vaccinated against tick-borne viral encephalitis, citizens from professionally threatened
contingents operating in the Russian Railways Company and living in endemic areas. The
incidence of tick-borne borreliosis is associated with the processes that occur in natural
foci (increase of the number of ticks, features of the circulation of the pathogen in natural
foci, and others.), but at this time diagnosis of this disease has improved.
Natural focal infections require a comprehensive study using the complex of
epidemiological, clinical, environmental and laboratory approaches.
RATIONAL COMBINATIONS IN THE TREATMENT OF
HYPERTENSION
Semdyankina Y., Telyakova A. – the 5th year students
Scientific leaders – Doc.Med.Sc, Prof. V. I. Pavlenko, E.A. Volosenkova.
ARTERIAL
Arterial hypertonia is a stable rising of systolic and diastolic arterial pressure at
double measurement.
There are several approaches to use a combination therapy. The first approach
— step (add-onapproach). The second approach — the use of the fixed combined drugs in
the form of advanced medicinal forms.
Now all possible combinations can be divided into several groups:
1. The most rational combinations: diuretic + ß adrenoblocker, diuretic + APF
inhibitor, beta adrenoblocker + antagonist of a calcium (dihydropyridinic), antagonist of a
calcium + APF inhibitor.
2. Possible rational combinations: diuretic + blocker of AT1 receptors, beta
adrenoblocker + a1-adrenoblocker, antagonist of a calcium + blocker of AT1 receptors,
antagonist of a calcium + agonist of imidazoline I1 receptors, APF inhibitor + agonist of
imidazoline I1 receptors, diuretic + agonist of imidazoline receptors.
3. Possible, but less rational combinations: antagonist of a calcium + diuretic, beta
adrenoblocker + APF inhibitor.
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4. Irrational combinations: beta adrenoblocker + verapamil or diltiazem, APF
inhibitor + potassium-sparing diuretics, antagonist of a calcium (dihydropyridinic) + a1adrenoblocker.
5. Combinations which rationality demands specification: APF inhibitor + blocker
of AT1 receptors, antagonist of a calcium (dihydropyridinic) + antagonist of a calcium (not
dihydropyridinic), APF inhibitor + a1-adrenoblocker, antagonist of a calcium + blocker of
AT1 receptors.
The choice of the initial scheme of medicamental correction of arterial
hypertonia remains empirical. The choice of an optimum combination, sequence and
priority of administration of the free and fixed combinations of anti-hypertensive agents
must be carried out taking into account sex, age of a sick person, accompanying factors of
risk and diseases. First of all the diabetes mellitus, gout, a renal failure, obesity, ischemic
heart disease and a hyperparathyreosis refer to them.
EXTINCT TWIN SYNDROME
Yunaev E. - 5th year student
Scientific leaders – Assoc. Prof. Can. Med. Sc. E.V. Shulzhenko, E.A. Volosenkova
Syndrome of the extinct twin (first described in 1945) is a very rare syndrome
characterized by multiple pregnancy with the subsequent disappearance of one or more
embryos. This syndrome is often diagnosed by ultrasound.
The extinct twinsyndrome may occur through complete lysis and fetal reabsorption,
«mummification» (fetal compression) and through the development of abnormalities
in the placenta.
Time of occurrence of this syndrome significantly affects the viable outcome of
a twin and pregnancy complications. For example, if the syndrome occurs in the second
half of pregnancy, the fetus may develop cerebral palsy.
Chromosomal abnormalities often lead to a syndrome of the extinct twin.
Constitution of A-plasma protein (PAPP-A) and free beta-HCG changes. AFP levels
are often elevated. The rate of increase of human-beta chorionic gonadotropin is slow.
The diagnosis is confirmed by detection of an empty gestational sac.
Simple extinct twin syndrome does not require any special medical treatment.
Doctors should carefully monitor the pregnancy. Viable twin should receive
specialized medical care.
SIAMESE TWINS
Eremenko V. - 5th year student
Scientific leaders – Assoc. Prof. Can. Med. Sc. E.V. Shulzhenko, E.A. Volosenkova
Fused or «Siamese» twins – a phenomenon when the complete separation of the
embryo into two does not occur, whereby the developing twins are not separated. There
are conjoined twins in 1 per 60.000 births. The earliest recorded case of the birth of
Siamese twins in the western world dates back to the year 945.
Twins are formed, when at one of the stages of development of the embryo
division into two parts occurs. If this separation occurs after 8 days of development,
conjoined twins are formed. Fusion of twins may be in the region of head (janiceps),
stomach (omphalopagi), coccyx (ischiopagi), breast (thoracopagi). Dicephali have a
common body and two heads.
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Prognosis for conjoined twins depends on the location, extent of connection
and the associated malformations. For ascertaining the potential for the survival of
children and their separation it is necessary to carry out echocardiography and
magnetic resonance imaging.
In case of diagnosing intrauterine coalesced twins abortion is recommended
in the early stages. But sometimes specialists adhere to expectant management until
fetal viability. Conjoined twins are born by caesarean section.
Separating conjoined twins is rather a difficult task. Therefore, the problem
involves not only medical problems but also legal, religious, and ethical aspects.
RENAL CORPUSCLES AND ITS ROLE IN THE FILTRATION OF URINE.
DISTURBANCE OF GLOMERULAR FILTRATION
Khlybova D. – the 2nd year student
Scientific leader - Prof. I.Y. Sayapina
One of the important functions of the kidney is involved in the regulation of the
concentration of osmotically active substances in the blood and other body fluids of the
internal environment, which is ensured by ultrafiltration in glomeruli, reabsorption, and
secretion of substances into the tubules, the synthesis of new compounds, the interaction
with hormonal, neural, vascular and other body systems. One of the main functions of the
kidneys is a long-lasting formation of urine. The main thing in this process is the renal
corpuscle, as the first stage of urine formation - filtration - takes place in this part of the
nephron.
The renal corpuscle consists of two structural components - vascular and glomerular
capsule. The diameter of the renal corpuscles is an average of 200 microns. Vascular
glomerulus consists of 40-50 loops of blood capillaries. Their endothelial cells have
numerous pores and fenestra (diameter up to 100 nm), which occupy not less than 1/3 of
the entire area of the endothelial lining of capillaries. Endothelial cells are arranged on the
inner surface of the glomerular basement membrane. From the outside it is on the inner
layer of the epithelium of the glomerular capsule.
Filtration barrier is almost impermeable to high-molecular substances. Normally, it
does not pass through the blood cells and some blood plasma proteins - immune bodies,
fibrinogen, etc., which have a higher relative molecular weight and a negative charge.
Under certain conditions, the kidney filter can be damaged. Disturbance of filtration
can be expressed in its increase or decrease irrespectively of the volume of liquid received
by the organism.
ALCOHOL – INDUCED LIVER INJURIES
Del V., Kablukova V. – the 2nd year students
Scientific leaders - Doc. Biol. Sc. I.Y. Sayapina, E.A. Volosenkova
There are three types of alcohol-induced liver injury: fatty liver (or fatty
degeneration), alcohol-induced hepatitis and cirrhosis.
Fatty degeneration of liver.
Fatty liver is the first and most common finding in drunkards. It is characterized by the
accumulation of triglycerides in the hepatocytes in the form of fat droplets. Fatty
degeneration is asymptomatic and is usually detected by chance during biochemical
studies, the results of which show abnormal liver function. The prognosis of fatty liver is
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favorable, provided that patients refrain from drinking alcohol. However, approximately
30% of patients who continue to drink alcohol, it progresses to cirrhosis within 10 years.
Alcohol-induced hepatitis.
It is caused by the toxic effects of alcohol on the liver cells. Histology is characterized by
fatty degeneration of hepatocytes, neutrophil infiltration and proliferation of interlobular
connective tissue. Similar symptoms are observed in other serious conditions, including
diabetes and obesity, in which they are called "NASH". The course of alcohol-induced
hepatitis can be asymptomatic but severe form manifests as jaundice.
Cirrhosis of the liver.
The most serious liver disease caused by alcohol is a cirrhosis. It is characterized by the
following histology-pericellular fibrosis (proliferation of fibrous connective tissue in
perisinusoidal spaces around hepatocytes). Patients have symptoms of a reduced liver
synthetic function and symptoms of portal hypertension (increased blood pressure in the
portal vein). The prognosis in alcoholic cirrhosis is unfavorable. Up to 90% of deaths
among patients with alcoholic cirrhosis are associated with liver disease; of which 33% are
caused by hepatocellular carcinoma.
APPLICATION FEATURES OF ADAPTOGENS
Donday-ool A., Hanmaa S – the 3rd year students
Scientific leaders - Doc.Med.Sc., Prof. N.V. Korshunova, E.A. Litovchenko, E.A.
Volosenkova
Adaptogens are preparations of mineral, vegetable and animal origin, which are able
to exert a powerful restorative effect, increase the tone of the organism, its performance,
immunity and resistance to pathogenic agents and to all environmental factors: cold, heat,
ionizing radiation, lack of oxygen, great exercise.
Adaptogens for children are recommended only in the form of drugs from natural plant
materials. To strengthen the immune system, to maintain health in a bad environment and
high mental, physical and mental stresses we recommend the following adaptogens for
children: a Green Light, phytocalcimin, Siberian ginseng, ginseng, immunal, arbidol,
galavit, aralias, ginger and buckthorn, ointments with bone tissues of deer horn, spotted
deer, or blood and secrets of animals glands.
Application features:
1. A small effect of adaptogens given after 15-30 days of continuous use.
2. Produced in the form of syrups, tinctures, tablets, extracts, powders, capsules, ointments,
suppositories, salves
3. Special attention should be paid to the choice of doses.
-small doses of adaptogens when properly used cause general relaxation, certain lethargy,
decrease general excitability
-average doses cause a mild stimulating effect, create sense of vitality, energy, there is an
emotional animation
-excessive doses can cause excitement, the emergence of irrability, insomnia, excessive
aggression.
4. Adaptogens are taken once a day.The intake of adaptogens several times a day and in
the evening can trigger insomnia. Adaptogens intake 2-3 times a day in order to increase
efficiency, may even significantly lower it.
5. Children under 16 years must consult a doctor because adaptogens accelerate puberty.
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Conclusion: thus adaptogens are widely applicable in areas of extreme climatic conditions;
adaptogens should be taken in the Far East respectively.
MORAL AND LEGAL PROBLEMS OF SURROGATE MATERNITY
Trebukhova A., Dorzhiev Z., Marushko L.-the 3-rd year students
Scientific leaders - A.I. Kovalenko, E.A. Volosenkova.
Surrogate maternity represents incubation and the child's birth under the agreement
signed between surrogate mother and potential parents whose gametes were used for
fertilization. For whom incubation and the birth of the child is impossible on medical
indications. Surrogate maternity is burdened by complex moral problems. 1) In case of
surrogacy the woman is simply alive incubator. Such situation is absolutely inadmissible
as it encroaches on the human dignity of the woman and on her right to be mother. 2) In
the case of surrogacy the child becomes an article.3) Surrogacy is the gross violation of the
rights of the child, first of all - on personal and family identity and specific communication
with the mother.4) Application of surrogacy has destructive influences on moral bases of
institute of a family and fundamental moral bases of the society.5) in case of the birth of
the sick child customers of services of surrogacy have the right to refuse such child, as a
certain "defective article". 6) Reference of surrogacy to the number of "methods of
treatment of infertility" has no grounds. Because in surrogacy application infertility doesn't
disappear. That is why everyone has the right to decide how to treat surrogacy. But it is
necessary to recognize that surrogacy is just the fact which was, is and will be.
THE FOOT FORM IN PERSONS AT THE AGE OF 16-25 YEARS
Karpova M. Sadursky I. – the 2nd year students
Scientific leaders - Can.Med.Sc., Assoc.Prof S.S. Seliverstov, E.A. Volosenkova
Flat foot is a foot deformity characterized by flattening its arches. There is
transverse and longitudinal flat foot, a combination of both forms is possible. Transverse
flat foot in combination with other strains makes up 55.23%, a longitudinal flat foot
combined with the other foot deformities make up 29.3%. Flat foot is a closely connected
with the body weight: the more weight is and, consequently, the load on the feet, the more
pronounced longitudinal flat foot. Longitudinal flat occurs most often between the ages of
16-25 years, the transverse flatfoot is between 35-50 years. The main symptoms of the
longitudinal flat foot - pain in the foot, changing its shape.
In case of less pronounced flat foot (I degree) fatigue appears in the legs after
exercise, with pressure on the foot pains appear. Gait becomes less plastic, often in the
evening foot swells.
In persons suffering from flatfoot of the II degree pain focuses not only in the feet,
but also extends to the ankles, shins. It is more severe and frequent. The muscles of the
foot to a large extent lose elasticity, and gait – loses its smooth.
Finally, the III degree of flatfoot is a pronounced deformity of the foot. Often,
patients only at this stage go to the doctor. After all the pain in the feet, lower legs, which
are almost always swollen, in the knee joints it is felt constantly. Loin often hurts, painful
headache appears. In case of the III degree of flatfoot sport becomes unavailable, ability to
work, is greatly reduced even a quiet, short walking is difficult. In a common shoe people
already can not walk.
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Prevention. Forming the correct correct gait means to avoid dilution of toes when
walking, so as not to overload the inner edge of the foot and supporting it ligaments,
parallel putting the feet and rest from time to time on the outer edges of the supinated feet.
THE MORPHOLOGY OF THE LIVER IN AUTOIMMUNE HEPATITIS
Ostapenko Y. - the 2nd year student.
Scientific leaders - V. S. Kozlova, E.A. Volosenkova.
The liver is the largest internal organ, performing the vital functions.
Hepatitis is inflammatory liver disease. Morphological changes in hepatitis are
associated with reactive changes. Usually the namber of collagen fibers increases.
Autoimmune hepatitis is chronic and often corresponds to severe chronic hepatitis.
The origin of autoimmune hepatitis, as of many other autoimmune diseases, is still
completely unknown. The essence of the pathological process is reduced to a deficit of
immune regulation. Along with the liver damage in the blood serum there is a broad range
of autoantibodies (antinuclear, microsomal antigen of liver and kidney, a liver specific
protein (LSP), and smooth muscle),and increased immunoglobulin G. Depending on the
set of detectable antibodies there are currently 3 types of autoimmune hepatitis.
Polymorphism of the hepatocytes and hydropic and balloon dystrophy are morphologically
pronounced. Regenerating hepatocytes with two or more nuclei are determined. There are
frequent focal (spotty) necroses of hepatocytes with lymphomacrophagal infiltration with
a mixture of a large number of plasma cells and the appearance in the portal tracts of
lymphoid follicles macrophage granuloma can be formed nearly. In autoimmune hepatitis,
the frequency of conversion to cirrhosis of the liver is higher, and prognosis is worse than
in patients with chronic viral hepatitis.
CAUSES OF NEONATAL JAUNDICE
Molchanov А. - the 2nd year student
Scientific leaders – N.A. Feoktistova, E.A.Volosenkova
The cause of hemolytic disease of the newborn is the incompatibility of the blood
of the mother and fetus in the group or Rh factor. Icteritionsness of the skin is caused by
the accumulation of hydrophobic form of bilirubin in the subcutaneous fat. However, the
real danger is the accumulation of bilirubin in the gray matter of the nervous tissue and the
nuclei of the brain stem with the development of «kernicterus» (bilirubin encephalopathy).
The severe anemia, reticulocytosis, erythroblastosis and normoblastosis,
hyperbilirubinemia due to indirect fractions of 100 to 342 mmol / l are detected in the
blood, the direct fraction of bilirubin increases in the future. The level of bilirubin in the
blood reaches the maximum level to 3-5 days of life. Physiological (transient) neonatal
jaundice develops 3-4 days after birth due to decreased activity of UDPglucuronosyltransferase in the first days of life, which is associated with increased
degradation of fetal hemoglobin and low activity of biliary tract. Hemolysis and anemia
are absent. The symptoms disappear within 1-2 weeks after birth. Serum concentration of
indirect bilirubin is increased to 140- 240 mmol / l. Jaundice in preterm infants disappears
in 3-4 weeks after birth. Increasing the concentration of indirect bilirubin in serum reaches
the maximum level in 5-6 days after birth and is more pronounced as compared with
physiological jaundice. Non-hemolytic neonatal hyperbilirubinemia caused by the mother's
milk, is found in 1% of newborns. The cause is inhibition of the activity of UDP155
glucuronosyltransferase presumably with estrogens of breast milk. Diagnostic criteria:
jaundice, sometimes with symptoms of CNS, increased indirect bilirubin concentration in
blood serum.
ANOMALIES OF THE NERVOUS SYSTEM (ANATOMICAL MUSEUM
MATERIALS OF THE AMUR STATE MEDICAL ACADEMY)
Molchanov A., Sergeeva A., Dzyuban M. - the 2nd year students
Scientific leaders – N.P. Ambroseva, E.A.Volosenkova
In the museum of the Department of Anatomy and Operative Surgery of ASMA the
preparations having congenital malformations of the central nervous system were detected:
12 preparations with anencephaly, 4 - with hydrocephaly, 4 - with a brain hernia, and 2 with a spinal hernia. Anencephaly - intrauterine fetal malformations which is formed
during the early stages of pregnancy in 21-28 days (unclosed anterior neuropore of the
neural tube). In 100% of cases this defect is fatal. Hydrocephalus - a disease characterized
by excessive accumulation of cerebrospinal liquid in the ventricular system of the brain as
a result of its difficulty to move from the place of secretion (ventricles of the brain) to the
place of absorption into the circulatory system (subarachnoid space). The emergence of
hydrocephalus in the newborn in most cases is caused by infectious diseases (CMV) during
pregnancy, leading to disruption of the ventricular system of the fetal brain. Brain
herniation (cephalocele) is a hernial protrusion in the cranial bone defect usually located
in places of the bone union. Meningocele is a protrusion of the dura mater through the
defect which is covered with the skin. The content of meningocele is cerebrospinal fluid.
Spinal hernia are congenital malformations of the spine and spinal cord, in the form of the
defect of the spinal canal through which the spinal cord sticks out. Thus its function is
greatly disturbed. The disease causes a disturbance of the legs (rarely hands) movements,
urinary and fecal incontinence and, consequently, causes the severe disability.
REPRODUCTIVE HEALTH OF MEN
Grigoriev D. - the 1st year student
Scientific leaders - Prof. E.N, Gordienko, E.A. Volosenkova.
Health - is a universal indicator of the quality of life. Questions of protection of
health in men today are more relevant than ever, because men's health is an index of
demographic, labor and defense capabilities. Despite the extremely poor state of men's
health, experts until recent were not engaged in this issue. The scientific community's
interests were mainly focused on the study of the problems of obstetrics and gynecology,
so the research, the subject of which are components of the reproductive health of men, are
rare. In science there are very little fundamental researches on men's health and
reproductive health of men in particular, the consequences of its damage for the individual
and society as a whole, moreover, a methodology for such studies is not developed.
Thus, it becomes increasingly clear that it is necessary to pay attention to men's
health. The State must realize that the protection of men's health, including reproductive
health, is a public safety task requiring legislative regulation.
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HEREDITARY DISEASES – ASPECTS OF TREATMENT IN THE XXI
CENTURY
Belyak Y. – the 1st year student
Scientific leaders – Doc.Med.Sc. E.N. Gordienko, O.I. Katina
Mucoviscidosis (cystic fibrosis) – is a systemic hereditary disease caused by a
mutation of the gene of mucoviscidosis transmembrane regulator. It is characterized by
lesions of exocrine glands and severe violations of respiratory function.
Mucoviscidosis is inherited in an autosomal recessive manner and is registered in
the most European countries, with a frequency of 1: 2000 - 1: 2500 newborns. In Russia,
the average frequency of disease is 1: 10,000 of newborns.
For the early detection the cystic fibrosis is included in the examination of newborns
for hereditary and congenital diseases.
70% of cystic fibrosis cases are detected within the first two years of the child‘s life.
With the introduction of neonatal screening the time of detection was greatly reduced.
There is a center of cystic fibrosis in the Republic of Tatarstan. At present, 73
patients are examined in the center. 13 of them are followed-up after an examination due
to the positive neonatal screening. The prevalence, epidemiological, genetic and other
characteristics of the disease are studied. With the introduction of neonatal screening the
detection time was greatly increased.
2017 – THE YEAR OF THE ENVIRONMENT IN THE RUSSIAN FEDERATION
Konev A., Umarova N. – the 2nd-year students
Scientific leader – Cand.Biol.Sc. L.A. Guba
In order to attract public attention to the issues of the Russian Federation
environmental development, the conservation of biological diversity and maintenance of
ecological safety the Decree «Year of Ecology» has been announced in the Russian
Federation in 2017.
For the environmental D-students "the coming year will be difficult. For those
companies that already follow responsible environmental policy, there will be new
opportunities for growth and long-term incentives to maintain the selected vector of
development…. Positive changes will be visible to everyone! ".
The main tasks to be solved in 2017:
Improving the legal and regulatory framework, governing the sphere of ecology,
and practical application of the amendments that have already been approved by a
parliamentary body;
Improving the environmental performance indices;
Formation of active citizenship in the field of ecology in the Russian citizens;
The development of Russian nature reserves system.
Thus, 2017 will be the year of ecology at once of double volume - attention will be
paid to both the improvement of environmental sphere as a whole and to the development
of the system of nature reserves individually.
What kinds of prospects are waiting us? In 2017 a significant tightening of regulatory
standards, governing the activities of state and commercial structures occurs in terms of
their impact on the environment. The new conditions will have to encourage companies to
be more responsible for the protection of all kinds of natural resources and for their
preservation against any negative impact.
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In particular, the amendments to the Federal Law "About Wastes" will come into
operation in the part of the regulatory process of emissions and discharges of wastes into
the atmosphere and into water bodies. The law will encourage businesses to use the best
technologies available today, which cause the least harm to nature.
However, experts have expressed the hope that the Year of Ecology, which is also
called a year of especially protected natural territories in Russia, yet will bring tangible
benefits to nature. Thus, it is expected that substantial assistance will go to those objects
located on the territory of our country, which are listed as UNESCO World Heritage Site.
If during the implementation of the action plan of the Year of Ecology (2017),
proclaimed by the Decree of the President, there will be the beginning of solving these
problems; the impact of this project can be assessed positively.
SUPPLEMENTS: TO FEAR OR NOT
Konev A., Ivashchenko V., Chernikova P., Mikhailova P. – the 2nd-year students
Scientific leader - Cand.Med.Sc. L.Ya. Etmanova
Substances added to food to improve its external qualities, taste, to increase the shelf
life expiration of food are called supplements. In recent years, it has become increasingly
difficult to find the products in which they are not contained. On the contrary, the number
of food supplements is increasing, more and more often unfamiliar names appear.
Food supplements have different functions, on this basis they are divided into some
groups.
Nutritional supplements improve nutrition value. They increase the content of
vitamins, minerals, fiber, fats and carbohydrates.
The function of keeping food safe is associated with antioxidants. Thanks to them,
food for a long time does not deteriorate and saves its appearance and taste.
There are specific nutritional supplements that help the products to acquire necessary
appearance.
Due to the chelating agents and sequestrants cream is whipped into soft foam and
milk coagulates into kefir.
Probably the most famous food supplements are preservatives. They preserve foods
and prevent the loss of taste and nutritional qualities. In ancient times sugar, salt, smoke
for smoking have been used as preservatives.
Another group of supplements, being a subject of much controversy is food grade
dyes. Both natural and synthetic dyes are added into the food. In recent years, organic dyes
have been used more frequently.
To improve the texture of products conditioners are used. Canned tomatoes remain
strong due to the addition of calcium and phosphates make the texture of products softer.
To thicken liquid and semi-liquid products emulsifiers are used, and into bread and
flour products an emulsifier which makes bread be soft and lush is added.
Sweeteners, flavors, thickeners, preservatives, dyes, and still many other substances
are added to products. Debates about the need for these supplements are not stopped.
Attitude to food supplements is different, but it is hard to find an indifferent person, because
they have a certain influence on health. Some scientists have argued that nutritional
supplements are harmless, while others consider them to be the cause of all diseases of
mankind. We won’t judge who is right and who is wrong, in any case, everyone should
know the meaning of labels on packages, and the meaning of letterings.
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HISTOLOGY OF THE ESOPHAGUS IN NORMAL CONDITION AND IN
CANCER
Umarova N. – the 2nd-year student
Scientific leader – Cand.Med.Sc. D.A. Semenov
Esophagus (Latin œsóphagus) is a part of the alimentary canal. It represents a
hollow muscle tube flattened anteroposteriorly through which food goes from the pharynx
to the stomach. The esophagus of an adult has a length of 25-30 cm. It is a continuation of
the pharynx. It begins in the neck at the level of the VI-VII cervical vertebrae, and then
passes through the thoracic cavity in the mediastinum and ends in the abdominal cavity at
the X-XI thoracic vertebrae, falling into the stomach.
The esophagus consists of mucosa, submucosa, muscular and adventitia
membranes. The mucosa and submucosa form in the esophagus 7-10 longitudinally
extended folds, protruding into the lumen.
The mucous epithelium of esophagus includes private and muscle plates. The
mucosal epithelium is multilayered, flat and not keratosic but at the elderly age its
superficial cells may undergo keratinization. In the epithelial layer there are 20-25 cell
layers. In human esophagus the flat cells of the surface layer of the epithelium contain a
small amount of keratohyalin granules.
The submucous base of the esophagus provides greater mobility of the esophageal
mucosa relative to muscle membrane. Together with the mucosa it forms numerous
longitudinal folds that are straightened during the ingestion of food.
Cancer of the esophagus is mostly associated with its epithelial cells of mucosa
(carcinoma).
PROBLEM OF EPONYMS IN THE STUDY OF INTERNAL MORPHOLOGY
Konev A. - 2nd-year student
Scientific leader - Cand.Med.Sc. Yu.A. Shakalo
In 1955, in Paris the VI International Congress of Anatomists for the first time in
the history of science has taken the official list of the Latin anatomical terms - Nomina
Anatomica, which was called the Paris anatomical nomenclature (PNA - Paris Nomina
Anatomica). This list was presented to the Congress of Anatomists by the International
Anatomical Nomenclature Committee that had held seven principles when preparing the
nomenclature guidelines, the latter of which reads: "Do not use in the official nomenclature
of descriptive and microscopic anatomy the eponyms (words derived from the proper
name of a real or mythical person or place)." Such strict limitation is due to the complexity
of adjustment the international list to numerous national nomenclatures since the same
structures have alternative proper names in different countries.
Later (1972-1974), in the development of Russian anatomical nomenclature, the
prohibition on the use of eponyms was not lifted, although something was mitigated. The
eponyms were allowed us to be used in cases when they are the basis for the formation of
clinical terms (maxillary sinus - sinusitis, Eustachian tube - evstahiit).
After the approval of the Russian version of equivalents of the International
anatomical terms (1974) eponyms disappeared from the textbooks of anatomy, whereas in
clinical practice, they are widely used. Moreover, the practitioners often replace the official
names for the eponymous terms (crural arch, Douglas space, Willis circle Pacchionian
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bodies, etc.). In the last edition of the International Anatomical Terminology (2003) with
an official list of Russian equivalents there is an alpha index of eponyms (400 terms).
Since in the Medical Universities anatomy for future doctors is taught but not
anatomy "in general", I believe it is important to answer the following questions: What
variant of a term to prefer: eponymous or official "anonymous"? Do all the official terms
have eponymous equivalents? Were there namesakes among the scientists whose names
we use as to anatomical terminology? How did the double terms such as PirogovWaldeyer`s ring appear? Are these results of the team-work or accidental occurrence?
And the most important question for a 1st-year student, how not to get lost in the
global diversity of terminological units and to learn correct ones, is solved easily - learn
official terms and remember those eponyms which are used in clinical practice. A list of
the latter has been prepared for the students of Amur SMA. Also, brief biographies of the
scientists who made a special contribution to the development of anatomy and whose
names are used to determine different anatomical structures of the human body are
presented.
TOOTH AS AN ORGAN. MORPHOFUNCTIONAL CHARACTERISTICS OF
VARIOUS TOOTH PATHOLOGIES
Ivaschenko V. - 2nd-year student
Scientific leader – Cand.Med.Sc. D.A. Semenov
Everyone should know the components of his body and the teeth as well.
A tooth is composed primarily of the dentin and cavity, covered by enamel and
cementum. The tooth has a characteristic shape and structure. It occupies a certain position
in the dentition, built from special fabrics. It has its own nervous apparatus, blood and
lymph vessels. Normally, a person has 28 to 32 teeth. The absence of third molars, called
"wisdom teeth" is the norm, and the third molars are already considered by an increasing
number of scientists to be a throwback, but it is currently a controversial moment. Inside
the tooth there is loose connective tissue, filled with nerves and blood vessels (pulp). There
are deciduous and permanent teeth - temporary and permanent occlusion. During the period
of the temporary occlusion there are 8 incisors, 4 canines and 8 molars - a total of 20 teeth.
Permanent dentition consists of 8 incisors, 4 canines, 8 premolars and molars (8-12), at that
the third molars are considered to be abnormal and often they are a subject to removal. In
children, the baby teeth begin to erupt at the age of 3 months. In the period from 6 to 13
years old deciduous teeth are gradually replaced by permanent.
As any organ the tooth has a number of functions: mechanical processing of food;
withholding food; participation in the formation of speech sounds and aesthetic. The teeth
play an important role in the mouth.
Teething in a man occurs twice: during the first period the eruption of 20 primary
teeth lasts for 6 months of age till 24-30 months of age, the second period - from 5 to 14
years, when there is a change to the permanent teeth. Wisdom teeth erupt at 17-25 or they
do not erupt at all. The terms of teething and the order of appearance can sometimes be
violated. Most often they are associated with the pathology of eruption of wisdom teeth.
There are cases where babies are born with already cut 1-2 baby teeth. Beginning with the
second half of the XX century teething occurs earlier, it is associated with acceleration.
The development of human embryonic teeth begins at approximately 7 week. In the
region of future alveolar processes a thickening of the epithelium takes place, which begins
to grow into the mesenchyme in the form of a curved plate. Further, this plate is divided
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into front and back, where the primordia of deciduous teeth are formed. Teeth primordia
gradually separate from the surrounding tissue, and then in them the component parts of
the tooth appear. The epithelial cells give rise to enamel. Dentin and pulp are formed from
the mesenchymal tissue. Cementum and root sheath are developed from the surrounding
mesenchyme.
Growing tooth pulp doesn’t play only the role of a nutrient; in children it is also a
source of stem cells that are important for the formation of dentine. Inhibition of pulp cells,
and thus the growth of the teeth can occur in children under the effect of high doses of local
anesthetics used in dentistry.
Human teeth are not regenerated while in some animals, such as sharks, they are
updated continuously throughout life.
There are various dental diseases such as caries, pathological abrasion of teeth,
pulpitis, periodontitis, parodontitis, dental tartar, hyperplasia of the tooth enamel and
others. In order to prevent the development of diseases one must follow the dental hygiene.
Oral hygiene is a means of prevention of dental caries, gingivitis, periodontal disease, bad
smell from the mouth (halitosis) and other dental diseases. It includes both daily brushing
habits and professionally cleaned teeth; the latter is carried out by a dentist.
This procedure involves the removal of dental tartar (mineralized plaque) that can
be generated even with careful brushing and flossing.
To care for the first teeth of a child it is recommended to use special dental wipes.
Items of personal oral hygiene: toothbrushes, dental floss, a tongue scraper. Hygiene
products: toothpastes, gels, rinses. But also do not forget to go to the dentist.
Thus, healthy, beautiful teeth are one of the constituent factors of natural beauty of
a person.
THE USE OF AROMATASE INHIBITORS IN ONCOLOGY PRACTICE
Kurilova I., Kostenko K. - the 4th-year students
Scientific leader - Cand.Med.Sc. V.I. Tihanov
Aromatase inhibitors have been applied in Oncology practice in the 70-80-ies of XX
century. Aromatase is a cytochrome P450-dependent enzyme responsible for the
conversion of androgens to estrogens synthesizing in the adrenal cortex. Aromatase is
present in various tissues and organs, including the ovaries, adipose tissue, skeletal muscle,
liver. Inhibition of aromatase reduces the formation of estrogens in women. The lack of
estrogens leads to the development of breast tumors.
The first and actually the only representative of aromatase inhibitors of the first
generation is aminoglutethimide - a nonselective aromatase inhibitor.
The search for new medicines with greater selectivity, better tolerability and more
convenient dosage regimen led to the development of aromatase inhibitors of the third
generation. They include nonsteroidal (letrozole, anastrozole etc.) and steroidal
(exemestane) compounds of this group.
The main indication for prescription of aromatase inhibitors is breast cancer in
postmenopausal women.
MICROSCOPIC COLITIS: CURRENT STATE OF THE PROBLEM
Lushnikova A. – the 5th-year student
Scientific leaders – Doc.Med.Sc. V.I. Pavlenko, Cand.Med.Sc. I.A. Bibik
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According to modern concepts, microscopic colitis (MC) is an inflammatory disease
of intestine with unknown etiology which is characterized by chronic watery diarrhea, lack
of macroscopic signs of lesions of the colon in the presence of specific pathological
changes.
Currently, the prevalence of MC is about 100 cases per 100,000 of the population,
which is comparable to other inflammatory diseases of bowel, such as ulcerative colitis
and Crohn's disease. MC is predominant in women usually over the age of 50 years. It
should be noted that 30-50% of patients with MC have at least one concomitant
autoimmune disease (Sjögren's syndrome, Raynaud's syndrome, rheumatoid arthritis,
psoriasis, celiac disease and hyper or hypothyroidism).
The etiology and pathogenesis of MC is not fully explored. The literature discusses
various factors (smoking, drug effect), and the mechanisms potentially associated with the
development of MC, including infectious and immunologic; malabsorption of bile acids;
genetic predisposition; disorders of collagen metabolism.
The main goals of treatment of MC patients are induction of clinical remission and
improvement of the life quality of patients. Currently, topical glucocorticosteroid
budesonide is the only drug efficiency of which both of the induction and maintenance of
remission for MC was proved in many clinical studies.
According to meta-analysis results, the induction of remission in patients treated
with budesonide in a dose of 9 mg/day for 6-8 weeks is about 80%. Considering the high
frequency of relapses after completion of induction therapy, which is 60-80%, it is
advisable to consider the tactics of assigning the long-term maintenance therapy up to 6
months.
THE SUBSTANCE STIMULATING THE NERVOUS SYSTEM
Karyakin M, Savchenko V. – the 4th-year students
Scientific leader – Doc.Med.Sc., Prof. V.A. Dorovskikh
Caffeine is one of the best natural stimulant that can be addictive, if you regularly
consume it in excess. This substance is called "the most popular legal drug in the world."
The main sources of this substance are coffee, tea, mate and chocolate.
Why caffeine “invigorates”? First of all, getting into the body, caffeine mimics
adenosine neurohormone that inhibits nerve impulses and causes drowsiness. Caffeine
blocks adenosine receptors in the brain and other organs, not allowing this substance to
communicate with them. Thus, it suppresses relaxation, increases the reaction rate and
attention. Secondly, caffeine stimulates the secretion of epinephrine, the hormone which
increases the heart rate and increases the pressure and increases blood flow to the muscles
and triggers delivery of blood glucose in its depot in the liver. Thirdly, caffeine improves
neurohormone dopamine in the brain. This substance is responsible for the sense of well
being and happiness. That feeling of vitality and recovery after a good cup of coffee is the
cause of addiction to caffeine.
When caffeine is safe? For most people a safe and healthy daily dose of caffeine
is 300 mg (three small cups of strong coffee). Some people have high sensitivity to caffeine.
100 mg of the substance may cause unpleasant symptoms of an overdose.
A lethal dose of caffeine is from 10 to 20 g (100 cups of coffee).
A list of symptoms of a caffeine overdose includes: heart palpitations, increased
anxiety, insomnia, diarrhea, frequent urination, dizziness, cramps in the stomach and
intestines, flushed face, thirst, nausea, and headaches.
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Sensitivity to caffeine: With age, sensitivity to caffeine is increased. Women are
more sensitive to caffeine than men. Cardiovascular diseases increase the susceptibility to
the effects of caffeine. The less people drink beverages rich in caffeine, the more they are
sensitive to the substance. About the compatibility of drug with caffeine is usually written
in the instructions for use; reduced weight increases the sensitivity to caffeine.
Abrupt cessation of the use of caffeinated beverages can cause withdrawal
symptoms. The more caffeine a person consumes, the greater his chances of developing
unpleasant symptoms caused by its absence. The first signs of "coffee withdrawal" begin
in 12-14 hours after the last cup of coffee or an energy drink.
Symptoms of caffeine withdrawal syndrome: fever, decreased attention,
depressed mood, concentration problems, drowsiness, headaches, irritability, muscle pain.
METHODS OF X-RAY EXAMINATIONS
Beglyanova A., Grishina M. - the 2nd-year students
Scientific leaders - L.G. Zherepa, Cand.Ped.Sc. Bibik
Techniques for radiographic examination are divided into: general and special.
General techniques are designed to examine any anatomical area and performed with
general-purpose X-ray machines (fluoroscopy and radiography) sometimes these
techniques are called specific.
Special techniques allow us to get an image with special devices designed to examine
specific areas and organs. A large group of examinations belongs to special techniques.
When involving images are obtained with the use of artificial contrast.
Special techniques:
Techniques with application of artificial contrasting are used in order to make organs which
cannot be seen on usual images visual. Substances, which absorb or let radiation of greater
or less intensity than the target organ pass, are introduced into the organism.
Air, carbon dioxide, nitrous oxides are used as contrast agents.
Techniques with the use of artificial contrasting are used to obtain ordinary images of
organs or their parts invisible on ordinary images. They are bronchography, barium enema,
cholecystography, cystography, fistulographyand etc.
Technique of artificial contrasting is currently the leading X-ray examination of most of
the internal organs.
Methods of artificial contrasting of organs.
There are two methods of artificial contrasting with the use of highly atomic substances.
1. Direct injection of contrast material into the cavity of an organ - the esophagus, stomach,
intestines, bronchi, blood vessels or lymph vessels, cerebrospinal fluid spaces of the brain
and spinal cord, etc.
2. The use of a specific ability of certain organs to concentrate some or other contrast
agents. For example, the liver, gallbladder and kidneys concentrate and excrete an iodine
compound introduced into the body. After administration such substances to a patient on
the images within a given period the bile ducts, gall bladder, abdominal kidney system,
ureter, and bladder can be seen.
Diagnostic pneumothorax - X-ray examination of the respiratory system after the
introduction of gas in the pleural cavity.
Sialography - X-ray examination of channels of salivary glands after their filling with
radiopaque medium.
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Enterograph - X-ray examination of a small intestine after filling its loops with barium
sulfate suspension.
Irrigoscopy - X-ray examination of a large intestine after filling its loops with barium
sulfate suspension.
Aortography - X-ray examination of an aorta after introduction into its lumen radiopaque
medium.
Phlebography - X-ray examination of veins after introduction into their lumen radiopaque
medium.
DIABETES
Pavlovskaya M., Avetisyan Ya., Kabar M.- the 2nd-year students
Scientific leaders - Assoc.Prof., Doc.Med.Sc. L.G. Tertychnaya, N.A. Feoktistova,
Cand.Ped.Sc. I.A. Bibik
The term "type 1 diabetes" is used to describe a group of disorders that develop as a
result of the progressive destruction of pancreatic beta cells, which leads to a deficiency of
proinsulin synthesis and hyperglycemia. The term "type 2 diabetes" refers to a disease
developing in individuals with an excessive accumulation of adipose tissue with insulin
resistance, so that there is an excess of insulin and amylin synthesis of pancreatic beta cells.
The term "gestational diabetes" is used in a pathological state - hyperglycemia that occurs
on a background of pregnancy in some women and usually disappear spontaneously after
delivery. Other forms of diabetes: insulin abnormalities or its receptors, the disease of the
exocrine pancreas, endocrine disease, Cushing syndrome, acromegaly, etc. There is a
genetic predisposition to diabetes. If one of the parents is sick, then the probability to inherit
diabetes of the first type is equal to 10%, and type II diabetes - 80%.
Regardless of development mechanisms, a common feature of all types of diabetes is
to increase the level of glucose in the blood and disturbance of metabolism of body tissue,
unable to absorb more glucose. This leads to increased catabolism of fat and protein with
the development of ketoacidosis. Increasing the concentration of glucose in the blood
increases the osmotic pressure of the blood, which causes serious loss of water and
electrolytes in urine.
Respiratory system. Diabetes is often associated with pulmonary tuberculosis. In
patients with diabetes, TB can occur as a result of infection or endogenous activation of
hidden pockets.
The reproductive system. In diabetes the genitals are affected. In men diminished
sexual libido or loss of libido and erectile dysfunction may often take place. In women
infertility may occur, spontaneous abortion, premature delivery, intrauterine fetal death,
amenorrhea, vulvitis, vaginitis may take place.
The nervous and muscular systems. There are the following forms of neuromuscular
disorders in diabetes: symmetric polyneuropathy; single or multiple neuropathy;
diabetic amyotrophy. The clinical picture distinguishes between two groups of symptoms:
1. Basic: polyuria (increased urine volume); polydipsia (constant unquenchable thirst);
polyphagia (constant unappeasable hunger); weight loss. This symptom is caused by
metabolic disorders, namely the inability of cells to absorb and process glucose in the
absence of insulin (hunger in plenty of food).
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2. Accessory: itching of the skin and mucous membranes; dry mouth; general muscle
weakness; headache; blurred vision; the presence of acetone in the urine in diabetes type
1.
Diet for diabetes is a necessary part of treatment, as well as the use of hypoglycemic
agents or insulin. Compensation of carbohydrate metabolism is not possible without
dieting.
CONTEMPORARY ISSUES OF THYMUS REGENERATION
Kabar M. - 2nd year student
Scientific leader - Assoc. Prof. T.L. Ogorodnikova
The thymus gland is a central body of lymphopoiesis and imunnogenesis. The size
of the gland changes with age and loses its most important function, an involution of the
organ takes place. The thymus consists of two lobes coated with capsular tissue and having
a lobed structure, where in each lobe there is the cortex and medulla. The epithelial tissue,
consisting of processed epithelioreticulocytes, is the base.
In the thymus there is its physiological regeneration, which is carried out by means
of appearance of new lymphocytes. Its epithelium becomes populated with blood stem
cells, which are differentiated into the cells of the thymus gland. An increasing number of
thymus lymphocytes gives rise to T-lymphocytes.
In the thymic stroma there are two types of long processed cells - dendritic and
interdigitating cells produced from precursors contained in the bone marrow. The thymic
dendritic cells are formed from lymphoid precursor. They present their own antigens in a
complex with molecules of the major histocompatibility complex I and II to autoreactive
thymocytes. The autoantigens are connected by Fas-receptors. It leads to apoptosis of Tcells. This process is called negative selection of T-lymphocytes. It provides central
immunotolerance. In using the low doses of toxins it is usually restored by reparative
regeneration, but because of large doses the T-cells irreversibly disappear and atrophy of
its stroma takes place.
Interesting information was obtained during an experiment to study microstructural
changes in the thymus after stress. The results showed that after stress the cortex and
medulla of lobules seem the same: they have almost no lymphocytes. High stress,
intoxication and other pathogenic factors cause depletion of thymic lymphocytes, a
violation of its stroma and loss of function.
Endogenous regeneration of the thymus can restore the immune system after stress,
infectious diseases and other impacts, resource-depleting immune cells. The recovery
mechanism is based on the action of interleukin-22 (IL-22). The study has shown that IL22 introduction increased the thymic regeneration after total radiation exposure. IL-22
mainly acts on thymic epithelioreticulocytes, stimulating their proliferation and increasing
their survivability in damaging effects. Expression of IL-22 is increased after the damage
of thymus in the cells-inductors of lymphoid tissue resistant to radiation; it is regulated by
IL-23.
The study of thymus involution contributed to the appearance of a new method of
regeneration of the thymus gland. During the experiment, scientists have increased the
level of protein FOXN1 in the body, produced by the thymus cells. Due to this protein
there is activation and deactivation of the genes responsible for the control of the
development of organ. The increase of the concentration of FOXN1 “reset" the thymus
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cells. The thymus recovered and regained its structure and size, but above all, it restored
the function of immunogenesis.
In conclusion we can say that the question of regeneration of the thymus is of great
importance in the treatment of many diseases, the development of this research will make
the greatest contribution primarily to the treatment of ontological diseases, HIV,
autoimmune diseases, pathological conditions of the thymus and other equally serious
diseases.
CORI CYCLE
Savostyanov D. – the 1st-year student
Scientific leader – N.A. Feoktistova
Cori sycle is a complex of biochemical and enzymatic processes of transporting lactate
from muscles to the liver with further synthesis of glucose from lactate catalysed by
enzymes of gluconeogenesis.
The biological significance.
In intensive muscular work and in the absence of mitochondria or in their insufficiency
(e.g., in the erythrocytes or muscles) glucose enters the pathway of anaerobic glycolysis
with lactate formation. Lactate can no longer be oxidized; it is accumulated (in its
accumulation in the muscles the sensitive nerve endings are irritated causing a specific
burning sensation in the muscles). With the bloodstream lactate is transported to the liver.
The liver is the main place where the enzymes of gluconeogenesis are gathered (synthesis
of glucose from non-carbohydrate compounds), and lactate participates in the synthesis of
glucose. The reaction of conversion of lactate into pyruvate is catalyzed by lactate
dehydrogenase. Further, pyruvate is subjected to oxidative decarboxylation, or can be
subjected to fermentation.
INTESTINAL DISEASES ON SAKHALIN
Grishina M., Avetisyan Ya. - the 2nd-year students
Scientific leaders - Assoc.Prof. Can.Biol.Sc. L.A. Guba, Cand.Ped.Sc. I.A. Bibik
During the period from 08.07.2016 to 15.07.2016. In the Sakhalin region 120 cases
of acute intestinal infections (83 of them in children under 17 years) were recorded. The
incidence rate was 24.6 per 100,000 of population. Morbidity in Smirnykhovsky (48.4),
Poronaisk (40.5), Uglegorsk (31.3), Aniva (27.2), Tymovsky (26.7), Nevel (25.3) districts
and Yuzhno-Sakhalinsk (32.5) was recorded above the regional index. In YuzhnoSakhalinsk, 65 cases of acute intestinal infections (children under 17 years - 44 cases) were
registered. The incidence rate was 32.5 per 100,000 of the population. In the Sakhalin
region (in Yuzhno-Sakhalinsk) 16 cases of enterovirus infection (1 case among children
under 1 year, 3 – among children from 1 to 2 years, 10 cases - among children from 3 to 6
years) were registered. The incidence rate was 3.3 per 100,000 population.
Disease level of enterovirus infection in the Sakhalin region was growing:
During the period from from 8 to 14 August 2016. In the Sakhalin region 128 cases
of acute intestinal infections (97 of them among children under 17 years) were recorded.
The incidence rate was 26.2% per 100,000 population, which is lower than in the previous
week by 11.1%. Incidence in Nevelsk (50.7), Makarov (36.4), Poronaisk (27.0), Nogliki
(26.2) districts and in Yuzhno-Sakhalinsk (41.0) were recorded above the regional index.
So in the regional center 82 cases of acute intestinal infections, including children under
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17 years - 66 cases were registered. The incidence rate in relation to the previous week was
lower by 9.9%. As reported in the regional Rospotrebnadzor, activation of the epidemic
process of enterovirus infection morbidity had been continued. During the period
mentioned above in the region 50 cases of diseases were recorded (10.2 cases per 100,000
population), it was higher than in the previous week by 41.1%. FSHI "Center of Hygiene
and Epidemiology in the Sakhalin region" found out pathogens of enterovirus infection in
the waste water and surface water body used for bathing.
Enteritis (“gut” - Greek) is inflammation of the small intestine, resulting in chronic
atrophy of the mucous membrane. The causative agents are enteroviruses belonging to the
picornaviridae family.
ELDERLY PATIENTS IN PRACTICE OF THE THERAPIST
Dmitrieva N., Zyabrina A. – interns
Scientific leader – Cand.Med.Sc. L.I. Bugayeva
The main features of patients of the advanced and senile age are:
 presence of involution, functional and morphological changes in the various organs
and systems;
 presence of several diseases in one patient (polymorbidity);
 predominantly chronic diseases;
 atypical clinical manifestations of disease;
 social-psychological maladjustment.
One of the characteristics of patients with middle and old age is polymorbidity, i.e.
presence in most of them several diseases, each of which has its specific manifestations,
peculiarities of the course of the disease, complications, a different outlook, differently
effects on the quality of life and requires appropriate individualized therapy.
In Russia the specialty of geriatrician was introduced in 1994 and the place of the expert
in the system of primary health care is not clearly defined, and his responsibilities are not
fully realized. So most of the problems associated with diagnostics, treatment and
rehabilitation of the elderly patients, still have to be solved by a therapist, who therefore
should have a broad general clinical training, the ability to solve many related, crosscutting issues.
The necessity of integrated doctor-patient relationship with the elderly patients on the base
of the broad clinical training of a doctor can be most clearly illustrated by the example of
managing a patient with diabetes. The character of the course of disease and the specific
complications of the disease, along with frequent comorbidities require that a doctor has
the related knowledge and skills not only in endocrinology (early diagnosis and selection
of adequate therapy), but also in such clinical fields as cardiology, nephrology, urology,
neurology, ophthalmology.
The main problems of drug therapy in elderly persons are:
 the need for the administration of more than one drug (forced polypharmacy);
 The need for prolonged use of drugs in connection with a chronic course of many
diseases (heart failure, diseases of the musculoskeletal system, hypertension, and
others.);
 violation of the pharmacodynamics and pharmacokinetics of drugs on the
background of age involution of organs and systems, as well as the existing geriatric
pathology;
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 Compliance violence - insufficient or improper execution of prescribed drug
therapy.
The early detection of adverse reactions to medication gets the importance in managing the
elderly patients. One should not only focus on the detected changes during the examination
or laboratory assessment, but also take into account the information obtained from the
patient and his family about the quality of patient’s life. Only the patient himself, of course,
in the absence of gross cognitive impairment can estimate even the minimum disruption of
quality of life, to which the doctor often does not pay special attention, evaluating only the
closest effect (reduction of blood pressure, pain management, and so on).
PROPHYLAXIS OF ENTEROVIRUS INFECTION
Aksenova A - the 2nd-year student
Scientific leader - Cand.Biol.Sc. L.A. Guba, Cand.Ped.Sc. I.A. Bibik
Enterovirus infections (EVI) represent a group of acute diseases caused by
enterovirus, characterized by a variety of clinical manifestations (from mild fevers to
severe meningitis). Enteroviruses are resistant to the external environment for a long period
of time and can be stored in the waste water, swimming pools, surface water bodies,
household items, food products (milk, fruits, vegetables). The virus dies quickly when
warming, boiling.
EVI is characterized by the rapid spread of the disease.
The source of infection: the sick and virus carriers.
Мodes of transmission: airborne, community-acquired, through food and water.
Symptoms: the body temperature of 39-40 degrees, severe headache, dizziness, vomiting,
abdominal pain, convulsions, catarrh of the oropharynx and upper respiratory tract.
Prophylaxis: 1) maintain personal hygiene rules, 2) drink only boiled water, 3) wash fruits
and vegetables thoroughly (then rinse them with boiling water).
ANALYSIS OF MORPHOLOGICAL CHANGES OF PLACENTA IN PATIENTS
WITH BRONCHIAL ASTHMA
Liyasova A., Repina J. - the 6-th year students
Scientific leaders – Prikhodko O.B., Kostrova I.V., Goryacheva S.N.
Placental insufficiency - a symptom arising in many pregnancy complications,
indicative about inhibition of gestational dominants. The development of placental
insufficiency associated with impaired maternal hemodynamics, aided by the complicated
course of pregnancy and extragenital pathology, including asthma.
The placenta has a large compensatory capacity, aimed at ensuring the normal
development of the fetal life. It is known that in chronic allergic inflammation in the
pathological process involves microvasculature placenta, thus disturbed the terms of its
formation. Effects of pathological factors on the placenta does not pass unnoticed, as
evidenced by the presence of pathological conditions such as inflammatory lesions,
degenerative and circulatory changes.
Have been analyzed morphological examination of placenta 42 patients with asthma
of varying severity. Group I consisted of 22 patients with asthma with acute exacerbation
of the disease during gestation (with uncontrolled asthma), II group - 20 patients without
exacerbations (partially or completely controlled asthma), III group - 26 pregnant women
without bronchopulmonary disease (control group). In 50% of cases detected placental
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insufficiency, while in 18% - sub- and decompensated, 8% of the observed breach of
maturation of the placenta. These data suggest that placental insufficiency in patients with
asthma (p <0,01), in particular, uncontrolled, has developed more than in the comparison
group (p <0,001).
It is known that the development of placental insufficiency slows down the process
of adaptation of the fetus and newborn, resulting to pathological conditions (predisposition
to posthypoxic encephalopathy, birth asphyxia, the development of immunodeficiency).
In the placenta of women of all groups were more frequent circulatory changes (p
<0,01), rarely - degenerative and inflammatory. In patients with asthma in the placenta was
dominated circulatory changes, combined with inflammatory and degenerative only with
uncontrolled course of the disease - in 10 cases. In the II group of patients the frequency
of circulatory and degenerative conditions placenta was close to the comparison group
indicators.
Detected during morphological examination a large number of villi with
degenerative changes of the stroma thereby reducing the permeability of placenta, fetal
hypoxia, metabolic, hypotrophic disorders, the appearance of pulmonary distress
syndrome.
The findings bring to the leading positions focal disorders of circulation in the
placenta, especially during exacerbation of asthma - hemorrhage and thrombosis,
infarction, necrosis, collapse intervillous space, uneven blood circulation and
vascularization of the villi, stasis, promote the development of fetal hypoxia.
Among the inflammatory changes that promote hypoxic state, more than ½ of cases
was dominated basal deciduitis, interviluzit, viluzit indicating disorders of utero-placental
circulation. Rarely observed membrane deciduitis, mainly in the group with exacerbation
of asthma during gestation (p> 0,05).
EARTHQUAKE ON SAKHALIN
Sergeeva A., Dzyuban M. – the 2nd-year students
Scientific leaders – Cand.Biol.Sc. L.A.Guba., Cand.Ped.Sc. I.A. Bibik
The strongest earthquake in modern history of Russia is the earthquake which
happened in May 1995 on Sakhalin in the city of Neftegorsk. It is impossible to find this
town on any map now. It was not rebuild after this catastrophe. All its houses were
destroyed by nature. The number of victims in the town was 2,000. The memorial and the
chapel were erected there. All the dead were buried near to them. According to the Richter
scale the magnitude of earthquake was 7.6 degrees. The earthquake was on May 28, in
1995 at 1:04 a.m. on the island of Sakhalin. It destroyed the town of Neftegorsk for 17
seconds. According to the Ministry of Emergency Situations of Russia 5,400 people lived
in Neftegorsk. 2040 of them died.
The earthquake on Sakhalin in the city of Nevelsk. 6.8-magnitude earthquake was
on August 2, 2007 at 1:37 p.m. Emergency regimen was introduced in Nevelsk. The
earthquake was accompanied by a seismic sea wave. The shoreline displacement towards
the land was 1.5 m. The height of waves was from 10 to 20 m. Near Yasnomorsk the height
of wave was about 2 m. As a result, two people died and 14 people were injured. There
were cracks in the walls of the houses, facades were broken, and Culture House was
destroyed. People left their homes, because they feared for their lives. Sakhalin is a very
beautiful island, with rich nature and interesting history. But this island has a volcano,
accordingly it has earthquakes.
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STRUCTURE AND REGENERATION OF PANCREAS
Tozhimamatov A. – the 2nd-year student
Scientific leader – Assoc. Prof. T.L. Ogorodnikova
Human pancreas (Latin- páncreas) is the largest organ of the digestive system (the
second largest after the liver), which plays a huge role in the digestive and metabolic
processes. The pancreas is a complex alveolar-tubular body elongated grayish-pink
color. Gland is covered with a thin connective tissue capsule. Under the capsule its lobed
structure is seen. It consists of a plurality of irregularly shaped lobes, closely adjoining one
another, separated from each other by the connective capsule. The pancreas contains
exocrine and endocrine parts.
Exocrine part. Exocrine part of pancreas is presented with lobules which are located
in the pancreatic acini and the tree-like system of excretory ducts: intercalary ducts and
interlobular ducts and, finally, common pancreatic duct, which opens into the duodenum.
The acinus of pancreas is a structural and functional unit of the organ. In shape acinus
presents the rounded form with the size of 100-150 microns, in its structure it has a
secretory department and intercalated duct, giving rise to the all duct system of the
organ. Acini consist of two types of cells: secretory - exocrine pancreatitis in an amount of
8-12, and ductal - epithelial cells.
Intercalated ducts pass into interacinar ducts, which, in turn, flow into the larger
intralobular. The latter continue into the interlobular ducts, which pass into the common
duct of the pancreas.
The endocrine part. The endocrine part of the pancreas is formed by acini which lie
between the pancreatic islets or islets of Langerhans. Islets are made up of cells - islet cells,
among which, basing on the presence in them different, according to physical, chemical
and morphological properties, granules, there are 5 main types:
• beta cells, synthesizing insulin;
• alpha-cells, producing glucagon;
• delta cells, forming cells somatostatin;
• D1-cells that produce vasoactive intestinal peptide (VIP);
• PP-cells, producing pancreatic polypeptide.
In addition, methods of immunocytochemistry and electron microscopy have shown
the presence of a minor amount of cells containing gastrin, thyroliberin and somatoliberin
in the islets.
The islets are a compact imbued with a dense network of fenestrated capillaries
arranged in clusters or bunches of strands of endocrine cells. Cells surround the capillaries
of islets layer by layer, being in close contact with the vessels; most of the endocrine cells
contact with vessels either through cytoplasmic islands or through adjoining to them
directly.
Function. Pancreas is an unusual organ. It performs at the same time two major
functions: digestive and endocrine. On the one hand, it produces enzymes to digest
food. On the other hand, it produces the well-known hormone insulin, the lack of which
leads a person to diabetes.
Pancreatic regeneration. In embryogenesis islets grow due to the proliferation of the
original progenitor cells and their differentiation into respective divergent cell differons. In
adults, the physiological regeneration of the acinar and islet cells occurs mainly by
intracellular updates of organelles. The mitotic activity of the cells due to the high
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specialization is low. After resection of a part of the body or organ damage some increase
in the proliferative activity of acinar cells, ducts and islets, the subsequent formation of
new acini are noted. However, the leading form of regeneration of exocrine part of gland
is regenerative hypertrophy. Restorative processes in endocrine part of the gland occur due
to the proliferative activity of islet and ductal epithelial cells by aсino-insular
transformation.
ORGANIZATION OF SORTING BRIGADS. SORTING GROUPS.
Komissarov A. – the 2nd-year student
Scientific leader – A.N. Miroshnichenko
Medical triage is an important aspect in the medical and emergency measures, since
it is important to provide (quickly and efficiently) assistance to the victims.
Sorting.
Medical triage is a method of distribution in the affected group on the basis of need
in homogeneous medical and evacuation activities, depending on the medical indication
and the specific situation. The sorting is based on three main sorting features: a danger to
others; therapeutic indication; evacuation sign.
First, there is selective sorting, to identify diseased, dangerous to others.
Therapeutic indication is the degree of needs of victims of medical care.
Evacuation sign is the need, the order of evacuation, transport mode and the position
of the affected transport.
Medical triage is one of the most important organizational methods aimed at a more
successful implementation of the two-stage system of treating people in emergency
situations.
LIVER REGENERATION
Altybaev Y. – the 2nd-year student
Scientific leader – Assoc. Prof. T.L. Ogorodnikova
Liver (Latin jecur, jecor, hepar.) is a vital exocrine gland of vertebrates, including
humans, located in the abdominal cavity (abdomen) below the diaphragm and performing
a wide variety of physiological functions. The liver is the largest gland of the digestive
tract. The surface of the liver is covered by a connective tissue capsule, which is tightly
fused with the piece of visceral peritoneum. Liver parenchyma is formed by the hepatic
lobules. The hepatic lobule is structural and functional unit of the liver.
The liver is one of the few organs that can recover its original size even when you
saved only 25% of normal tissue. In fact, regeneration is happening, but very slowly, and
the quick return of the liver to its original dimensions occurs but mostly because of the
increased volume of the remaining cells.
Liver regeneration is a complex of tightly regulated physiological processes
implemented to maintain correct hepatocyte proliferation and nonparenchymal cells, as
well as the restoration of the impaired organ function after injury. Factors produced by the
liver and extrahepatic tissues and interacting with specific receptors of the cell membranes
regulate this compensatory mechanism.
It is believed that in the absence of stimulation of growth the hepatocytes divide
once or twice in their lifetime. After removal or damage of the liver the mechanism that
leads to hyperplasia of the surviving cells, stromal recovery and hypertrophy of the
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remaining part of the liver, which is regulated by a variety of factors, starts. Experiments
have shown that the biosynthesis of proteins of several functional classes, including
transcription factors and growth-signal transmitting proteins starts 5-6 hours after partial
hepatectomy (phase G1). In 10-12 hours after surgery, the increased synthesis of DNA
(phase S), reaching a maximum in about 24 hours is noted. In 7-10 days after restoration
of
the
initial
liver
mass
the
process
of
regeneration
stops.
Based on the above study, it can be said that the liver is a vital human body that can be
regenerated more than 50% of its own tissues and after completion of the regeneration
process, the organ doesn`t lose its function.
EARTHQUAKES IN ITALY
Mongush A., Beglyanova A. – the 2nd-year students
Scientific leader – L.A. Guba
Seismically dangerous areas occupy about 50 % in Italy. About 3 million inhabitants
live in the high risk zone. According to geologists, during just one year there are about 2
thousand earthquakes.
The largest earthquake of magnitude 6.0 was at the night of Wednesday, on August
25. Small towns Amatrice, Accumoli and Pescara del Tronto were most affected.
As to the population of these towns, it was increased due to travelers including
children spending holydays there.According to the data there were 295 dead, over 400
injured and 55 people were in shock. More than 2500 people appeared to be homeless. All
the victims were transported to hospitals by ambulances of the Rome.
This earthquake was the largest catastrophe in the history of the country since 2009
(that year when there was an earthquake in L’Aquila in the Abruzzo region claimed the
lives more than 300 people).
In addition to the said above the devastating earthquake which destroyed the city and
killed many lives was on the same day as the day-death of Pompey.
HOMOCYSTEINE IS A NEW RISK FACTOR OF ATHEROSCLEROSIS AND
THROMBOSIS
Yakimenko S. – the 2nd-year student
Scientific leader – Cand.Biol.Sc., Assoc.Prof. G.K. Doroshenko
Cardiovascular diseases and especially coronary heart disease are among the leading
causes of disability and mortality worldwide. The presence of hyperhomocysteinemia
increases the risk of early development of atherosclerosis and thrombosis of the coronary,
cerebral and peripheral arteries despite traditional risk factors and it is a predictor of
mortality. In the pathogenesis of atherosclerosis sluggish inflammatory process in the
vessel wall, which is manifested at all stages of development and damages the
atherosclerotic plaque, plays an important role. Accumulating in the body, homocysteine
begins to "attack" the inner wall of the artery - the intima, covered with endothelium.
Endothelial damages, provoking clots and atherosclerotic plaques appear.
Homocysteine was discovered in 1932, when L. Butz and V. du Vigneaue had
received and described the previously unknown substance. It is a product of the conversion
of amino acid methionine. In 1964 T. Gerritsen and H. Waisman described the genetic
defect of one of the enzymes involved in the metabolism of homocysteine. Clinically, the
disease was manifested by the increased levels of blood homocysteine and homocystinuria.
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Homocysteine could appear in urine. Multiple lesions of vessels, thromboembolism, which
led to an early death at the age of 30 years, took place.
A new stage in the study of homocysteine is associated with the understanding of the
important role of this substance in the development of cardiovascular disease. In 1976, D.
Wilcken and B. Wilcken were the first to discover the fact that in adult patients suffering
from cardiac vascular disease (stenocardia), violations of homocysteine exchange are often
found. Today hyperhomocysteinemia is considered to be a cause and a marker of
hypertension.
Homocysteine is a sulfur-containing amino acid that does not occur in natural proteins
consumed with food, but it is an intermediate in the methionine and cysteine metabolism.
A new test was recently developed to measure the concentration of homocysteine, based
on principles of immunoassay.
THE LARGEST PLANE CRASHES IN 2015-2016
Ivaschenko V., Klochkova V. - 2nd-year students
Scientific leader – Cand.Biol.Sc. L.A. Guba
Air transport is the quickest, but at the same time it is the most expensive way of traveling.
The main scope of airline service is Passenger Transportation over distances of more than
a thousand kilometers. There are also freight transportations, but they aren't so popular. In
some regions, there is only air transport. That is why people have to use it. Nowadays, we
often face crashes and people started to ask themselves: "How can we stay alive after such
trips?"
When aircraft accidents happen, we can see destruction of the plane of different types.
There are many multifatality accidents.
There are also many different reasons of crashes, but the most dangerous reasons, which
we can face very often, are fires and explosions on the board of the plane.
Rescue and emergency workers are always quick. They must evacuate people immediately,
after the landing.
First aid is given to every victim immediately. The captain is in charge of all the work and
everyone. Both a crew and passengers must follow his instructions.
A321 plane crash in Egypt. 224 dead. Airbus A321 took off on October 31 from the airport
of Sharm el-Sheikh to St. Petersburg, and 20 minutes later disappeared from radar. The
Egyptian authorities found the wreckage in the north of the Sinai Peninsula, in the
mountains. The vast majority of the victims are the Russians. The main version of the crash
is now called a technical fault.
Indonesia July 1, 2015. 141 human bodies were delivered to the hospital from the place of
the crash of military transport aircraft C-130 Hercules. Among the dead both servicemen
and local residents, the majority of victims were not identified. A large fire broke out at
the crash area. The basic version of the crash is considered to be an engine failure.
24 March 2015 Airbus A-320, flying from Barcelona to Dusseldorf, crashed in the French
Alps. On the board of the airbus there were 150 people, including six crew members. They
all died. As it turned out, during the flight the pilot Andreas Lubitz locked the cockpit door
and deliberately sent the airbus down.
MOSCOW, August 3, 2016, Emirates Airline plane caught fire while landing in one of the
largest harbors in the world of air - Dubai International Airport. Unsuccessful landing made
Boeing-777, performing flight EK521 from India Thiruvananthapuram. All passengers and
crew were evacuated.
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THE STRUCTURE AND PHYSIOLOGY OF RED BONE MARROW
Avetisyan Ya. – the 2nd-year student
Scientific leader - Assoc.Prof. T.L. Ogorodnikova, Cand.Ped.Sc. I.A. Bibik
The red bone marrow is a central organ of parenchymal blood, in which the formation
of blood cells except for T- lymphocytes takes place. In the adult human the red bone
marrow cells are located in cancellous bones (epiphysis of long bones and in the spongy
flat bones). In children all bone marrow is red and at the age of 12-18 years in the diaphyses
of long bones it is replaced by yellow (adipose tissue). In a healthy person as an adult the
bone marrow is about 4.6% of total body weight, but only 1/3 of it remains in a
physiologically active state and performs its functions to maintain and restore the normal
blood. The yellow bone marrow is the stock from which the body draws on its recovery
reserves in injuries and diseases.
There are 4 components of the red bone marrow:
1)
Stromal component
2)
Macrophagic component
3)
The vascular component
4)
Hemal component
Part of the stem cells of the red bone marrow can turn into one of the forms of blood
cell elements. The red bone marrow is permeated with numerous fibers of the nervous
system with the nerve endings, which are actively involved in the hematopoietic process.
The yellow bone marrow can be transformed relatively quickly into its active form at high
blood loss. Transformed into the red bone marrow, it begins to perform blood formation
function. In fact, the yellow and red bone marrows are the same living tissue structure,
existing in two different states: in “working” and in "standby." A living organism is
constantly under attacks of microorganisms and in the process of life it loses its cells. It is
constantly fighting against viruses, bacteria and microbes, continuously excreting the
remains of dead cells and is engaged in the restoration of damaged tissues. All these
processes occur in the blood. Therefore, the blood cells do not live long, even during
normal operation of the body in a healthy condition; i. e. the red marrow is continuously
executing the function of the blood update. But most clearly it is manifested in extreme
cases: large blood loss, extensive thermal burns of the body, deep mechanical injuries,
acute occurrence of infectious diseases, etc.
RESULTS OF OPTIC NERVE ELECTROSTIMULATION IN COMBINATION
WITH THE USE OF MEDICATION CORTEXIN IN PATIENTS WITH
GLAUCOMA
Bekker A. – the intern
Scientific leaders – Cand.Med.Sc., Prof. V.N. Krasnogorskaya, A.A. Petrova
Glaucoma is one of the most urgent and important problems in ophthalmology. The
significant spread of glaucoma, difficulties of early detection and poor prognosis are the
main reasons which have some effect on the attention of many researchers to the disease.
A comprehensive treatment of stabilized open-angle glaucoma was provided by
electrostimulation and neuroprotector cortexin. 32 patients (56 eyes) with stabilized openangle glaucoma were observed at early stages. All patients were made injections with
peptide neuroprotector cortexin in the dose of 10 mg (0.5 ml) under the conjunctiva in the
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lower-outer quadrant, then electrical stimulation of the optic nerve was performed. To
evaluate the results of treatment visometry, perimetry, tonometry were used and
electrosensitivity and electrolability of the optic nerve were taken into account. The use of
electrostimulation with neuroprotective therapy allows us to achieve an improvement in
visual acuity up to 84% by 0.14 ± 0.06, expansion of peripheral visual field by a mean of
60 ° (total degrees of 8 meridians) in 91% of patients. Comprehensive treatment of primary
open-angle glaucoma improves visual function and stabilizes glaucomatous process during
6 months.
SURGICAL CORRECTION OF CONGENITAL AND ACQUIRED
DEFORMITIES
Teplyashin D., Lomidze Yu. – the 3rd-year students
Scientific leaders – Prof. V.V. Grebenyuk, Cand.Ped.Sc. Bibik
In the world the number of people in need of surgical correction has significantly
increased recently. Because of it the necessity of reconstructive surgery, mainly related to
reconstruction of parts of the body, organs, skin damaged as a result of traumas and
diseases, and congenital defects of the human body is increased.
In this paper we consider methods for correcting such deformities as cleft lip, cleft palate
and reconstruction of the auricle. To eliminate the deformation of facial soft tissues and
facial bones, surgeons widely use osteosynthesis with application of titanium plates, bone
grafting, distraction devices, implants, tissue expansion, and various types of flaps and
grafts.
Types of plastic surgery for the cleft palate are:
 veloplasty – correction of soft palate
 uranoplasty – correction of the hard palate.
When planning operation the degree of damage of the velopharyngeal shutter is taken
into account, and the place from which the seized plastic material will be taken, is
determined. In most cases, correction of the cleft is carried out with the use of grafts,
isolated from the lateral portions of the hard palate. For large crevices the muscular and
mucous layers, separated from the tongue or cheeks of the patient can be used.
Stages of reconstructive otoplasty:
• the Formation of a cartilaginous skeleton (donor tissue: rib or cartilage);
• Reconstruction of earlobes;
• the Establishment of the auricle (formed angle);
• the Creation of basic elements (tragus, antihelix, fossa).
Stages of reconstructive otoplasty are the individual interventions, between which there is
a break of 1-4 months needed for healing.
The stages of uranoplasty are:
• Separation of the plastic material.
• Lengthening of the soft palate.
• Stitching a defect.
• Reduction of the middle part of the throat.
• Suturing.
• Antiseptic treatment.
• Plates overlaying on the soft palate.
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RECOVERING OF A SPINAL CORD FROM A TRAUMA
Gromova A. – the 2nd-year student
Scientific leader – Assoc.Prof. T.L. Ogorodnikova, Cand.Ped.Sc. I.A. Bibik
The human spinal cord is able to restore its functions even after its damage to 90% of the
volume of the spinal cord.
In cases of the complicated spine injury there is no complete diametral injury of a spinal
cord with destruction of all its fibers. In most cases these patients become severely disabled
with total absence of hopes for restoration of any lost function. There is a discrepancy
between complete dysfunction of a spinal cord and preservation - after a trauma - of
minimal but enough amounts of fibers.
At the time of damage a death of a part of axons, neurons and glia occurs, but at the same
time the mechanisms of the secondary, delayed damage are started: vascular and
inflammatory responses, development of apoptosis of the neurons and glia. A considerable
number of conductors due to a trauma are demyelinated. In case of remyelination there is
a considerable improvement of their conductivity. Prevention of secondary injury of axons,
myelin, a stimulation of myelination can help to preserve the escaped part of functionally
full-fledged fibers and to provide with their help a function restoration.
Functional regeneration of axons is their growth in length with establishment of contacts synapses with cells-targets. During the usual course of traumatic process it is possible to
observe a formation of new branches – the process has received the name of "sprauting".
A source of these branches are cells of own conduction tracts of a spinal cord, the cells of
sensitive ganglia. These intact cells give rise to collateral branches and form synapses with
cells which have been connected with the long-tract axons injured after a trauma. Such
changes can't be called true regeneration of the damaged cells, but they are compensatory
reorganization of intercellular communications which under favorable conditions (lack of
spinal cord compression, sufficient blood supply, a free flow of cerebrospinal fluid) can
provide some reduction of neurologic deficit by 1-2 segments.
It is important as inclusion of functionally significant segments of a spinal cord, for
example at the cervical level, can improve the quality of life of a patient considerably.
Existence of sprauting indicates a potential possibility of axons growth. Theoretically the
reasons of bad growth of axons can be either low potential abilities of axons to regeneration
or the cellular environment, slowing down their growth.
VOLCANIC ERUPTIONS DURING LAST 5 YEARS
Mikhailova P., Chernikova P. – the 2nd-year students
Scientific leader – L.A. Guba, Ph.D.
Volcanoes are geological formations occurring over channels and cracks in the
Earth's crust that erupt at the earth's surface. There are valid, which either continuously or
intermittently erupt, dormant and extinct volcanoes, without any historical data. Almost
90% of active volcanoes are located in the so-called zone of Tierra del Fuego - the chain
of seismically active zones and volcanoes, including underwater, stretching from the coast
of Mexico to south through the Philippine and Indonesian archipelagoes and to New
Zealand. According to various estimates, in the world there are about 1,000-1,500 active
volcanoes.
There have been dozens of eruptions, including last five years:
2011. Grimsvotn - a volcano in Iceland.
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2013. Paluweh – a volcano in Indonesia.
2014.Baurdarbunga - a volcano in Iceland.
2014. Ontake - Japan volcano.
2016. Sinaung – a volcano in Indonesia.
2016. Klyuchevskoy – a volcano in Kamchatka.
Volcanoes can be exciting, challenging, but at the same time dangerous.
Understanding how a volcano can affect - is the first step to mitigate its risk.
The consequences of volcanic eruptions:
1. Lava flows.
2. Pyroclastic flows.
3. Volcanic ashes.
4. Lahary.
5. Volcanic gases.
After analyzing the causes and consequences of some volcanic eruptions, we can
evaluate the ravages of volcanoes in different parts of the world and learn how to navigate
the global diversity of the seismically dangerous areas.
SYSTEM “MOTHER – FETUS”
Mikhailova P. – the 2nd-year student
Scientific leader - D.A. Semenov, Ph.D
The system “mother-placenta-fetus” is a single functional system, which is formed
immediately after conception and ensures the maintenance of optimal conditions for
development of the embryo and the fetus in pregnant women.
Features of the functional system “mother-fetus”:
1. The existence of this system is limited to a period of pregnancy
2. Only a woman's body is capable of formation of this functional system
3. In the process of formation and development of a functional system “mother-fetus”
normal and pathological processes take place.
4. In its formation and development, there are "critical periods".
5. Functional system “mother-placenta-fetus” has its ultimate goal. It is not only the birth
of alive, full-term and viable newborn but also an optimal adaptation of the woman's body
to the gestational process.
The interaction of the mother and the fetus carries through the interaction of several
functional systems of the body: the nervous, digestive, endocrine, immune, respiratory,
cardio - vascular.
Thus, the functioning of the system “mother-fetus interaction” is provided by a
number of functional systems both in a mother and a fetus. During its normal operation
harmonious development of the fetus without harming health of the mother happens.
Violations can lead to the abnormal development of the fetus and acute diseases of the
mother, and in the worst case to miscarriage or death.
ENDOGENOUS OPIATE PEPTIDES
Mikhailova P., Chernikova P., Nevedomskaya O. – the 2nd-year students
Scientific leader – Cand.Med.Sc. I.V. Siyanova
Opioid peptides represent a group of neuropeptides, which are endogenous ligands
for opioid receptors antagonists. These peptides consist of 10-15 compounds, each
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molecule comprises from 5 to 31 amino acids. They include endorphins and enkephalins.
Both are produced by the central nervous system and are involved in the regulation of
behavior and pain by acting on opioid receptors.
Anatomical localization:
Endorphins are located near the back border of the anterior lobe and the nerve fibers in the
posterior lobe of the pituitary gland of a man. Neurons, where biosynthesis of endorphins
occurs, are located in the hypothalamus and have long processes, penetrating into other
parts of the brain. For example, they penetrate into the parts of the brain associated with
the limbic system. They contain significant amounts of immunoreactive ß-endorphin which
allows us to assume that it effects on memory, learning and emotions.
Enkephalins are situated in the spinal cord, in the digestive tract, in the adrenal
chromaffin cells (stored in the secretory granules with catecholamines). Enkephalin release
occurs as a part of the sympathetic response to stress.
Anesthesia:
ß-endorphin. Electrical stimulation of brain regions involved in the transmission of pain
impulses (periventricular gray area) results in pain relief, followed by an increase in the
concentration of endorphins and enkephalins in the cerebrospinal fluid.
Enkephalin. In the dorsal horn of the spinal cord it is released by interoceptive neurons,
which interact with afferent fibers (associated with sensation of pain) extending from the
periphery. These fibers transmitting pain impulses form synapses in the gray matter of the
posterior horn of the second set of neurons. These fibers extend upwards through the spinal
cord and cross it, forming the lateral spinothalamic pathway. The release of enkephalins
inhibits the release of substance P (neurotransmitter mediating the transmission of pain
impulses) from afferent fibers included in the dorsal horn.
Thermogenesis. Peptides, similar to endorphin and encoded in the precursor molecule, such
as g-Melanocyte stimulating hormone (g-MSH), cause a rapid decrease in body
temperature.
Reducing stress. High levels of serum ACTH and cortisol during the stress are
accompanied by the increased secretion of ß-endorphin and ß-lipotropic hormone.
Interactions with the immune system.
Endogenous opiates provide a biochemical link between the brain, the neuroendocrine
system and the immune system and can serve as an explanation of the concept that
emotional stress is accompanied by violation of the immune response.
Blood pressure and shock. Severe hypotension or shock stimulate the release of ßendorphin from the pituitary gland.
Other physiological effects are seizures, regulation of body temperature, appetite
control, reproductive function, sexual behavior, the release of hormones of the
hypothalamus / pituitary, memory change, regulation of breathing.
Clinical significance. After researching nature and properties of the endogenous
opiates information about the treatment of mental illness, the pain associated with
reproductive function, appetite control, obesity, drug addiction can be obtained.
INCURABLE PATIENTS – EXPEDIENCE OF THE PALLIATIVE SURGERY
Lashuk A., Matrahova A., Cherenkova A. – the 3rd-year students
Scientific leader – Prof., Doc.Med.Sc. V.V. Grebenyuk, Cand.Ped.Sc. I.A. Bibik
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Relevance of the research topic: The increase of number of incurable patients that need
palliative care and medical social assistance has been noted in different countries of the
world in the last decade.
Aims and objectives: To explain the meaning of the terms “incurable patient” and
“palliative surgery”. On the basis of questionnaire to learn students' attitudes to incurable
patients and to the problem of providing palliative care.
An incurable patient is a patient who at a certain stage of treatment, when to ease symptoms
is the only possible type of medical care, was recognized as not curable. The main purpose
of palliative care is improving quality of patient's life despite low life expectancy. The main
principle is no matter which disease a patient suffers from, no matter how serious illness
is, no matter what means of treatment were used for patient's treatment, there always will
be some ways to increase the quality of patient's life on his remaining days. Palliative
surgery is a type of surgery which is used in oncology due to a late diagnosis of cancer and
impossibility of radical therapy due to last stages of the disease.
According to the survey, positive attitude to providing palliative surgeries dominates
among the third year students of Amur State Medical Academy. Students think that surgery
for incurable patients is necessary in spite of the stage of disease. Decision about the
relevance of palliative care and performing sparing and organ-modeling operations should
be based on the individual assessment of patient's condition. If it is technically possible,
there should be chosen a method aimed at preserving quality of patient's life.
PROTEOLYSIS. UBIQUITIN-PROTEASOME SYSTEM.
Mikhailova P., Nevedomskaya O. – the 2nd-year students
Scientific leader – Prof. E.A. Borodin
Proteolysis is a process of hydrolysis of peptide bonds catalyzed by proteolytic
enzymes (proteases).
In place of the substrate molecule attacks proteolytic enzymes are divided into
endopeptidases and exopeptidases:
1.Endopeptidase or proteases cleave peptide bonds within the peptide chain.
2.Exopeptidases hydrolyze peptides from the end of the chain: aminopeptidase - Nterminal end with carboxypeptidase — C-terminus.
Proteases are also classified by their mechanism of action and by types of catalysis
(serine proteases, aspartic proteases, cysteine proteases, metalloproteases).
The action of proteolytic enzymes can be divided into two categories:
1. Limited proteolysis in which protease specifically cleaves one or more peptide
bonds in the target protein, which usually leads to a change in the functional state of the
latter: the enzymes, for example, become active at the same time, converting into
prohormones and hormones;
2. Unlimited or total proteolysis when proteins are broken down into single amino
acids. Proteolysis occurs by complete removal from the body of abnormal proteins
produced by mutation and due to biosynthetic errors.
Ubiquitin-dependent proteolysis is the process of hydrolysis of abnormal proteins.
The process involves two stages: the covalent attachment of ubiquitin chains of the protein
molecules and proteosome degradation.
Ubiquitin is a peptide consisting of 76 amino acids.
The main primary and secondary signals for attachment of ubiquitin can be classified
as follows: the conformation of the peptide N-terminal region, particularly the presence of
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"destabilizing» N-terminal or another free; a-amino group ( “N-end rule") or specifically
positioned lysine substrate; certain short sequence motifs in the amino acid residue (rather
than an entire three-dimensional structure of the protein molecule); violations of the
secondary structure of the protein (abnormal clotting) polypeptide chain; damage to the
side chains of amino acid residues, including their oxidation (e.g. oxidation of methionine
residues); excessive glycosylation of proteins and peptides.
Its attachment to the protein takes place in three stages, with the participation of the
three groups of enzymes E1, E2 and E3.
hydrolysis stages:
1. Activation of PU (PU-activating enzyme E1);
2. Binding of activated PU (PU-bearing enzyme E2);
3. The formation of a specific complex between the PU - E3 ubiquitin-protein ligase;
4. The transfer of PU activated protein without the participation of E3;
5. Ubiquitin binding to the protein and formation of multi-PU chains with the release
of free E2;
6. Degradation of the ubiquitinated protein 26S by proteasome;
7. Removal of the PU of "erroneously" ubiquitinated proteins by isopeptidase;
8. Release of the PU of degraded protein;
Thus, proteolysis plays a significant role in these processes in the body:
1. Splitting food proteins into amino acids through their action on digestive enzymes
in the stomach and small intestine;
2. Splitting their own proteins during metabolism;
3. Formation of enzymes, hormones and bioactive peptides from their inactive
precursors;
4. In plants proteolysis is involved in the mobilization of seed storage proteins during
germination.
Modification of ubiquitin plays an important role in the regulation of gene expression
of the cell cycle and cell division, to cell stress response, in DNA repair, apoptosis, in
biogenesis of the mitochondria and ribosomes, as well as in the removal of normal and
mutant proteins short-lived.
THE ROLE OF INTESTINAL MICROFLORA IN OBESITY
Karapetyan E. – the 3rd-year student
Scientific leader – Prof., Doc.Med.Sc. G.I. Chubenko
Intestinal microflora has important metabolic functions, such as the destruction of
food toxins and carcinogens, the synthesis of micronutrients, enzymatic digestion of food
components, participation in the absorption of certain electrolytes and microcells, the
impact on growth and differentiation of enterocytes and colonocytes as well as their
metabolic activity which contributes to the "extraction" of calories from the absorbed
nutrients and helps to store this energy in the body fat depots.
Recent research has shown that obese people and people with normal body weight
may have different intestinal microflora, which plays an important role in the regulation of
body weight and may cause the development of obesity in some people.
It was found that in the intestines of obese people there are fewer bacteria of family
Bacteroidaceae and more bacteria of the Firmicutes family in comparison with people with
normal body weight.
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In research on experimental animals the mechanisms mediating the effect of intestinal
microflora on the accumulation of energy of food was investigated.
The microflora was shown to ensure absorption of monosaccharides from the
intestine and to increase lipogenesis in the liver. These effects are mediated by two
signaling proteins - ChREBP (Carbohydrate Response Element-Binding Protein) and
SREBP-1 (Sterol Regulatory Element-Binding Protein type-1).
Besides the intestinal microflora suppresses intestinal FIAF (Fasting-Induced
Adipose factor), which firstly leads to the increase of lipoprotein lipase activity in
adipocytes that promotes fat accumulation in fat depots and, secondly, suppresses the
production of PPARγ-coactivator that increases the expression of gene regulators of
mitochondrial fatty acid oxidation.
Thus, the intestinal microflora affects both the extraction of energy from the
consumed nutrients, and the expression of genes regulating the energy consumption and
the energy storage.
Another possible mechanism, linking gut microbiota to obesity is based on the fact
that LPS (endotoxin) of gram-negative bacteria of the GIT can serve as a link between
inflammation and metabolic syndrome.
In experimental animal studies the higher-fat dietary interventions were shown to
increase endotoxemia.
And chronic endotoxinemia induced the expression of
proinflammatory cytokines such as TNF-α, interleukin-1, interleukin-6, plasminogen
activator inhibitor type 1 that promote obesity, insulin resistance and diabetes
Thus, the existing data provide a basis for further research of the role of intestinal
microflora in the pathogenesis of obesity, and also point to its potential modifications in a
comprehensive treatment of this disease.
DOWN SYNDROME
Alatortseva M. – the 1st-year student
Scientific leader – V.A. Naumenko
Is Down syndrome a disease?
Down syndrome is a genetic abnormality and a congenital chromosomal disorder that
appears as a result of increasing number of chromosomes.
Such a violation is very frequent in 1 child out of 650 newborns. The term «Down
syndrome» implies a certain set of characteristics and traits, which were described by an
English physician John Downey in 1866.
Causes of Down syndrome
In 93 years in 1959, a French scientist Gerard Lejeune revealed the true cause of the
syndrome - the appearance of an extra chromosome. The cells of a human body contain 46
chromosomes. In the children born with Down syndrome, the 21st pair has an extra
chromosome, resulting in presence of 47 chromosomes. So, this is the main cause of Down
syndrome.
Symptoms of Down syndrome
You can see symptoms of Down syndrome after the birth of a baby. There are pronounced
physical differences: flat face, oblique slant of palpebral fissures, abnormal skull shape,
short upper and lower limbs and short fingers.
Unusual children, usually they are called "children of the Sun" often have heart defects,
mental retardation, decreased muscle tone, violation of movements coordination. These
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children start to walk, talk later, but many of them have an ear for music and they are very
merry, kind and helpful.
The forms of Down syndrome
1. Trisomy means the presence of 3 chromosomes instead of 2.
2. Translocation Down syndrome is gene transfer or transfer of a chromosome fragment to
a different location in the same or another chromosome.
3. Mosaicism is a third type of chromosomal abnormalities. It is expressed by the presence
of normal quantity of chromosome - 46 in some cells and in other - 47 chromosomes, i.e.
there is trisomy of the 21st chromosome.
Down Syndrome treatment
Down syndrome is considered to be incurable.
Science has made a leap forward and now the introduction of stem cells allows us to effect
on all systems of a child’s body positively and to strengthen the immune system, to treat
the damaged tissues. This treatment significantly normalizes the growth of bone; restores
functions and develops the brain. The treatment should be timely; it must begin
immediately after birth.
HELMINTH INFECTIONS AND DIARRHEAL SYNDROME
Cherepenko A. – the 5th-year student
Scientific leader – P.K. Soldatkin
Helminthiasis is a parasitic disease caused by various types of parasitic worms.
Enterobius vermicularis is a pathogenic agent of Enterobiasis. Its early symptom is
perianal itching. Initially itching appears periodically and becomes unbearable when a
massive invasion occurs. It causes insomnia, severe neurasthenia, and loss of working
capacity. Children become fractious, irritable, their memory and academic performance
are getting worse and they suffer from sleep disturbances and epileptic seizures. In the
areas of itching inflammations, abrasions, fractures and eczema appear. And then the signs
of the secondary infection which lead to the development of pyoderma become evident.
Frequent, loose stools with an admixture of mucus may appear.
Tichocephalus trichirus is a pathogen of Trichocephalosis. The first clinical
symptoms are a decreased appetite, nausea, vomiting, bloating, severe cramping in the
abdomen sometimes without specific localization. The chronic diarrhea, tenesmi, weight
loss may appear. Stool is muco-bloody, sticky with very thick and viscous mucus.
Ascaris lumbricoides is a pathogen of Ascaridiasis. Allergic reactions appear: cough,
running nose, hives, and itching, low-grade fever. There are signs of pneumonia and
bronchitis. Asthmatic attacks are possible. There is combination of eosinophiliae and
migrating infiltrations in the lungs (Loeffler`s syndrome). Symptoms of intestinal stages
are changes in appetite (usually food refusal), nausea, belching, heartburn, sometimes
vomiting, pain and bloating. There are frequent diarrheas or alternating between diarrhea
and constipation. Due to the toxic effect on the central nervous system there are hysterical
attacks, epileptiform convulsions, meningitis, as well as the violation of functions of organs
of vision.
Thus knowledge of the clinical picture of helminth infections contributes to the timely
implementation of the specific therapies that are beneficial in the course of the diseases
and their prognoses.
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CLINICAL FEATURES OF VIRAL DIARRHOEAS
Saaya N. – the 5th-year student
Scientific leader - P.K. Soldatkin
The features of viral diarrhoeas are: acute onset, rapid spread in different foci, the
high resistance of the pathogen in the environment and its high infectiousness,
asymptomatic carriage and continued abjection of the originator into the environment after
clinical recovery.
Rotavirus (rota (lat.) – a wheel, rotatory - rolling). The incubation period continues
from 15 hours to 3-5 days. An acute onset is typical. The main clinical symptoms are: fever,
repeated profuse vomiting and diarrhea. Abdominal pains localized in the epigastric,
umbilical areas are noted. Stools are frequent, copious, watery, frothy, yellow or yellowgreen color with a pungent smell.
Norovirus infection (“cup” - Latin). The incubation period is 12-24 hours. The clinical
picture is characterized by a triad of symptoms: fever, vomiting, diarrhea. Vomiting is
usually a predominant symptom in children, and diarrhea in adults. The disease begins
abruptly with the appearance of abdominal pain, nausea. Then vomiting and diarrhea join.
Stools are frequent, watery. The disease is usually mild. In children of the first year of life
the absence of a feverish reaction is noted.
Adenovirus infection often strikes young children. The incubation period is from 8 to
10 days. A special feature of enteropathogenic adenovirus is the absence of nasopharyngitis
and keratoconjunctivitis. The main clinical symptoms are: watery diarrhea, vomiting, fever
up to 37.5-38.5 ° C, drowsiness, lethargy. Sometimes in toddlers gastroenteritis may occur
with mesenteric adenitis, which gives a picture of acute abdomen and leads to
intussusception.
Thus, knowledge of the clinical and epidemiological picture of viral diarrhea will
contribute to the timely and adequate therapy. It will favorably impact on the course of
disease and its prognosis.
AMUR REGION HERBAL REMEDIES TO COMBAT OBESITY
Menovschikova O., Suvorova A., Timofeeva A. - the 4th-year students.
Scientific leader - Can.Med.Sc. V. I. Tihanov
The World Health Organization announced that the increase in body weight (hereinafter
obesity) has become a global epidemic, and poses a serious threat to public health due to
the high prevalence. Thus with increasing body weight occur heart disease, blood vessels,
liver, leading to chronic illness and premature death.
In addition to a healthy diet and lifestyle protected from excess weight are the alkaloids,
plants with effects:
1. anorectic (sage, peppermint, dandelion ordinary, swede);
2. lipolytic (elder flowers, birch leaves, burdock root);
3. saharozameschayuschy (chokeberry Aronia, blueberries bog);
4. normalizing cholesterol, sugar, and triglycerides (onion, garlic, nettle, yam, hawthorn).
Herbal medicine with the use of the above plants Amur region to prevent and to conduct
prevention of complications such as type 2 diabetes, hypertension, atherosclerosis,
coronary heart disease and other diseases, and helps to improve the condition of patients.
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THE STORY OF THE APPEARANCE OF THE X-RAYS
Kalmykova A., Boldyreva V. - the 1st-year students
Scientific leaders - L.G. Zherepa, Cand.Ped.Sc. I.A. Bibik
The story of the appearance of the X-rays is associated with the name of German
physicist Wilhelm Conrad Roentgen. The discovery of the X-rays was accidental and
happened because of great watchfulness. A cathode ray tube was wrapped with black paper.
On the table there was a green-paperboard, coated with a layer of cyanoplatinite barium.
Studying the phenomenon of the passage of electric current through special tube Roentgen
noticed that every time the screen lighted up brightly. So the X-rays were discovered; they
are capable to pass through the bodies, impenetrable to the visible light. It happened on 8
November 1895. Basing on X-ray data, a Russian inventor A.S.Popov constructed the Xray tube and a first X-ray machine. It served as an impetus for further use of X-rays in
medicine.
V.M.Bekhterev wrote:"... as it became known that some solutions don't allow
roentgen rays to pass through them, the cerebral vessels may be photographed in situ. In
general, I think, the use of X-rays in the nervous and mental pathologies could be
considered as a perspective work.
Taking into account the Roentgen`s merits in Leningrad (now St. Petersburg) the first
world's monument was erected, and one of the streets was named after him as well as the
institute of radiology.
MORPHOLOGICAL STUDENT PASSPORT AS A FORM OF ACTIVATION OF
INTEREST IN A HEALTHY LIFESTYLE
Mayorova A., Sulitseva E. – the 1st-year students
Scientific leaders – L.G. Zherepa, Cand.Ped.Sc. I.A. Bibik
The process of creation of «the morphological passport» includes a study of the
anthropometric characteristics according to the particular scheme (growth, weigh, chest
circumference), calculation of Quetelet and Pinye indices, determination of harmony of
development and somatotype, thickness of a fat roll, proportionality of extremities
segments and their form, description of the skin “drawing” of fingers, iris of an eye, size
of the pelvis, determination of the arch of the foot and many other things carried out by a
student.
It should be noted that platypodia is a deformation of foot which is characterized by
consolidation of the arches of feet. Today it is one of diseases which is very widespread
among people.
The examination of iris of an eye attracts great interest of students because it is a reflector
of the congenital deficiencies fixed in a genotype.
Experience shows that morphological certification of students is rather a progressive way
of study of anatomy through "the interest in one`s own body", and also one of important
factors of influence on the motivation for further physical perfecting and maintaining a
healthy lifestyle.
CHOLERA: FROM "A" TO "Z"
Lushnikova A. – the 5th-year student
Scientific leaders – P. K. Soldatkin, Cand.Ped.Sc. I.A. Bibik
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In the world structure of morbidity the highest proportion of cases of cholera is
associated with the African continent - 76.27%. In the Americas it is 18.97%, in Asia 4.76%, and in Europe - 0.001%.
In Asia, the epidemic process of cholera was characterized by: gradual spread of
infection on the continent; seasonality; increase of the risk of spread of cholera due to the
contamination of water sources and water management, unsanitary conditions;
intensification of epidemic manifestations in a camp for displaced civilians during armed
conflict. Epidemics and outbreaks in Asia caused by strains of V. cholerae 01 biovar El
Tor, Serovar Ogawa with cholera toxin of classical biovar (CTX) and allele-7 ctxB gene.
V. cholera strains characterized by multiple antibiotic resistances were identified in Nepal.
Africa. The dynamics of morbidity showed a tendency to decrease in 2014. All
regions of the continent were found to be affected by cholera. The endemic areas, where
the epidemic manifestations took place, appeared due to emergency situations of natural
and mainly of social nature. The epidemiological situation has been caused by: the
continuation of epidemics since November 2013; the rapid spread of infection, high
morbidity and mortality; domestic and interstate migration, creation of critical situations
due to scarcity of water sources, low sanitary conditions in the camps for displaced persons,
their overcrowding; social risk factors: lack of adequate sanitation, safe drinking water,
participation in the burials of the dead from cholera; drinking water with causative agent
of cholera from open reservoirs; natural factors; an insufficient number of medical
personnel, lack of medicines and other resources.
America. Caribbean countries: reduction of morbidity was found in 2014. Haiti:
despite the decline of morbidity, there are still conditions for the spread of the disease: lack
of access to safe drinking water and poor sanitation. Cuba: there were the following factors
of pathogen transmission: eating food bought from street vendors and lack of access to safe
drinking water. Europe. Only sporadic importation of cholera infection was noted. Except
for the Ukraine (2011) the spread of infection wasn’t observed in Europe. CIS countries.
Cholera is marked in Kazakhstan, the Ukraine and the Donetsk region.
Russia. Importation of V. cholerae 01, biovar El Tor, Serovar Ogawa serotype into
Murmansk Oblast and into Moscow from India and into the Tver region, and Moscow from
Tajikistan are typical. Importation of cholera caused by non-toxigenic Vibrio cholerae 01
biovar El Tor, Serovar Ogawa serotype into the Rostov region from Tajikistan was marked.
In connection with the release of toxigenic strains from the water objects the operational
plan of sanitary and anti-epidemic measures for the elimination of cholera was
implemented.
Thus, in the world since the beginning of the XXI century an intensive and large-scale
spread of infection in Africa, Asia, America with the importation of infection into
Europe, Australia and Oceania, the Americas, the United States and Canada related to
emergency situations of natural and social nature has been established. Along with the
epidemics and outbreaks of V. cholerae 01 El Tor and multi-resistant strains with multiresistance to antibiotics, in the countries of Southeast Asia outbreaks of V. cholerae 0139
serogroup take place. Prediction of cholera in the world remains poor. It speaks in favour
of the fact that there is a possibility of importation of infection into Russia.
THE LEVEL OF ALEXITHYMIA IN CHILDREN OF SECONDARY SCHOOL
AGE ACCORDING TO THEIR LEVEL OF PHYSICAL DEVELOPMENT
Lushnikova A., Kiselko M. – the 5th-year students
Scientific leaders – Can.Med.Sc. O.S. Yutkina, Cand.Ped.Sc. I.A. Bibik
185
The problem of the study of alexithymia in modern science has polydisciplinary
nature. The main direction of the study of this phenomenon doesn’t give an unambiguous
interpretation of its formation and development mechanisms. It is commonly postulated by
the authors that alexithymia should be considered to be non-specific risk factors of
psychosomatic diseases.
The aim of the study is to identify the phenomenon of alexithymia in children of
secondary school age depending on their level of physical development.
The research was conducted on the basis of secondary school №5, among the
children of the secondary school age (16-17 years), using a procedure called Toronto
alexithymia scale.
Results of the study. The study involved 60 participants. Among them 11 people
had mikro-somatotype, 32 – mezo-sometotype and 17 – makro-somatotype. Of the total
number of children with mezo-somatotype non-alexithymic type of the personality had
31.25%; with mikro-srmatotype – 27.27% and with makro-somatotype 47.06%. The risk
group included 37.5% of children with mezo-somatotype, 27.27% with mikro-somatotype,
47.06% - with makro-somatotype. The group with alexithymia amounted to 45.46% of
children with low level of physical development; 31.25% with average physical
development and 5.88% with high level of physical development. At the same time, as to
the distribution of personality types based on gender, in the group of children with mezosomatotype the alexithymic type and the risk group consisted mostly of girls - 50% and
58.33%, respectively. Girls (alexithymic personality type) accounted to 100% in the group
of the children with mikro-somatotype and girls accounted to 66.67% in the risk group as
well. Among the children with makro-somatotype (the risk group) and alexithymic
personality type there were boys (100% and 62.5% respectively).
Thus, children with alexithymia mostly can be present in the group of children with
mikro-somatotype, at the same time girls appeared to be the main part of this group. For
them it is difficult to recognize and express their feelings and emotions. Most of the
children with makro-somatotype are characterized by a decrease of the ability of
verbalization referring to emotional states, which means they are in risk group. Moreover,
the boys dominate in this group. It must be noted that the risk group, though it doesn’t refer
to an "alexithymic" type of personality, but it is associated with the borderline level and,
basing on our results, the percentage of children with non-alexithymic personality type is
much less than percentage of children with alexithymia and less than percentage of those
who are members of the risk group as a whole.
Based on these data we can conclude that alexithymia is actually combined with a
variety of factors, including the level of physical development. It can serve as a ground for
the development of psychosomatic disorders, indicating a need for diagnostic and
preventive measures for children in order to correct their physical development and
psychological adjustment.
ABNORMALITIES OF THE URINARY SYSTEM (ACCORDING TO THE DATA
OF THE ANATOMICAL MUSEUM OF ASMA )
Yakimenko S., Rozuvaeva M., Snegirev D. – the 2nd-year students
Scientific leader – N.P. Ambroseva
Abnormalities of the urinary tract are the most common defects of human
development. Anomalies of the kidneys make up about 40% of all the vices of human
development. Malformations of the kidneys and urinary tract may be single or multiple. In
186
most cases, in kidney abnormalities a violation of the outflow of urine from the body, and
this violation of renal hemodynamics, which is a pathogenic factor for the development of
pyelonephritis, stone formation, hydronephrosis and other pathological processes take
place. The origin of human malformations remains unclear. Usually there are causal and
formal genesis of malformations of all organs and systems, which can be considered,
respectively, as the etiology and pathogenesis of malformations. In respect to the organs of
the urinary system between the causal genesis and etiology an equal sign can be put,
whereas the formal genesis of kidney defect is not always its pathogenetic mechanism.
Originally, the causal genesis of all the vices of kidney development is divided into
congenital and hereditary. Birth defects are the consequence of fetal diseases and are most
commonly associated with exogenous damaging factors such as exposure to ionizing
radiation, drugs and chemical agents, steroid hormones. Hereditary malformations are
associated with abnormal chromosomal apparatus. There are about 40 types of kidney
malformations related to hereditary. Formal genesis of vice kidney development is
considered in connection with the embryogenesis of the body. Different malformations are
determined at pronephros stages, at the archinephron one and at the stage of the formation
of permanent kidney. It should be remembered that the kidney and upper urinary tract
develop from completely different anlages that initially are not connected with each other.
Many authors explain the extraordinary diversity of kidney malformations pointing to these
circumstances. In the Anatomical Museum of ASMA there are the following preparations:
a kidney with two ureters - 4 samples, doubling of the renal pelvis system - 3 samples,
fused kidney - 3 samples, horseshoe kidney - 3 samples, lobed kidney- 2 samples. It should
be stressed that they make up a large percentage of abnormalities of the urinary system.
THE LEVEL OF ANXIETY IN CHILDREN OF OLDER SCHOOL AGE
DEPENDING ON THEIR PHYSICAL CONDITIONS
Lushnikova A., Kiselko M. – the 5th-year students
Scientific leaders – Can.Med.Sc. O.S. Yutkina, Cand.Med.Sc. I.A. Bibik
Anxiety as a stable personality trait is being formed mainly in adolescence. Based
on this, school age, with its problems of adaptation, is making greatest interest for the study
of specific manifestations of the anxiety phenomenon in connection with problems of
psychoprophylaxis, psychocorrection of different states of maladjustment, which, as
known, can be a risk factor in the development of somatic pathology.
The aim of this study is to investigate the level of anxiety in children of older school
age and different physical conditions.
The hypothesis of the study based on the assumption that the level of physical
development of a child affects on the existence of the anxiety with certain psychological
content.
Materials and methods. The study was conducted on the basis of secondary school
№5, among children of senior school age (15-17 years), using a procedure Multidimensional assessment of children's anxiety (MSCA).
Results and its discussion. Totally 56 respondents participated, 29 boys
(mezosomatotype - 12 makrosomatotype - 17) and 22 girls (mezosomatotype - 15
makrosomatotype - 7). Girls (mezosomatotype) having a low level of anxiety constitute
3.33%, average - 90%, high - 6.67%. At the same time the girls (makrosomatotype) with
low levels of anxiety - 7.14%, average - 64.29% and high - 28.57%. The boys
(mezosomatotype) with low levels of anxiety - 16.67%, average - 75% high - 8.33%. The
187
boys (makrosomatotype) with low - 26.46%, average - 52.95%, high - 17.65% and the
extremely high level of anxiety - 2.94%.
Thus, analyzing the results of the evaluation of gender-specific and physical features
of the dynamics of anxiety in older children it can be said that the research hypothesis is
confirmed - the level of physical development of a child affects on the existence of the
anxiety with certain psychological content. It can serve as a ground for the development of
psychosomatic disorders, indicating a need for diagnostic and preventive measures for
children in order to correct their physical development and psychological adjustment.
FLOODING IN PRIMORSKY KRAI IN 2016
Ivanova E., Fakeeva M. – the 2nd-year students
Scientific leader – Assoc.Prof. L.A. Guba
A typhoon resulted in the terrible consequences in Primorye in 2016. Despite the fact
that the people in general are accustomed to flooding, which happens in late August - early
September, the current flooding at the scale of floods was the most horrific in a long time.
The typhoon "Namtuen" made the locals think of the sad, as it poured in the form of
new rainfalls, which largely led to an increase in water level in rivers.
Experts promised that typhoon "Namteun" would pour to 1.5-month norm of
precipitation on the affected areas of Primorye. The worst consequences of the disaster
were in Dalnegorsk city district, Partisansky, Olginsky and Terneisky districts.
In particular, on 5 and 6 September 2016 heavy rains were in the region. Forecasters
had predicted the formation of the second wave of floods, increasing the length and depth
of flooding plains with located on them the objects of economy and infrastructure.
Besides post-typhoon (typhoon "Lionrock) damage surveys determined the
reconstruction of houses and other objects would cost 1.2 billion rubles.
According to the operational calculations, after the typhoon "Lionrock" more than
one thousand people were evacuated from their places of residence. Most of the locals are
still in temporary accommodation.
USE OF VAGINAL RINGS CONTAINING DAPIVIRINE FOR HIV-1
PREVENTION IN WOMEN
Soyotova N. - the 4 th -year student
Scientific leader - Cand.Med.Sc. R.A.Anokhina
More than half of the 35 million persons currently living with human immunodeficiency
virus type 1 (HIV-1) infection are women. A majority of these women reside in subSaharan Africa, a region that has some of the highest incidences of HIV-1 infection in any
population worldwide. The use of antiretroviral medications as pre-exposure prophylaxis
is a promising approach to the prevention of HIV-1 acquisition. Several clinical trials of
the antiretroviral tenofovir showed such protection against HIV-1.However, in three trials
involving African women, adherence to tenofovir-containing pills and vaginal gels was
low, and HIV-1 protection was not shown.
Vaginal rings can provide sustained and controlled release of medications. For example,
rings containing exogenous hormones are licensed for contraception and estrogen
replacement. For HIV-1 prevention, an antiretroviral-containing vaginal ring could provide
long-acting HIV-1 protection while reducing systemic exposure to the active
pharmaceutical ingredient and delivering the anti–HIV-1 agent at the site of viral
188
transmission. Dapivirine is a non-nucleoside HIV-1 reverse-transcriptase inhibitor that has
activity against a broad range of HIV-1 subtypes. In two trials, genital biopsy tissue
samples obtained from women using dapivirine vaginally in the form of a ring, films, and
gels were substantially less susceptible to HIV-1 when challenged ex vivo than were tissue
samples obtained from placebo-treated women. A monthly vaginal ring containing
dapivirine was found to be safe and acceptable in phase 1 and 2 studies, with typical plasma
levels of the drug that were lower by a factor of 1000 than levels in women receiving oral
dapivirine.
INVOLUTION OF THE THYMUS
Sholokhova I. – the 2nd-year student
Scientific leader – Assoc.Prof. T.L. Ogorodnikova, Cand.Ped.Sc. I.A. Bibik
The thymus is the central organ of the immune defense and lymphocytopoiesis. It
reaches its maximum development in early childhood. In the period from 3 to 20 years a
stabilization of its mass is observed. After 20 years, the process of age-related thymus
involution of the thymus has to happen (reverse development). This process is a gradual
transformation of the thymus into the “fat” body. This is accompanied by a decrease of the
number of lymphocytes, particularly in the cortex, the appearance of lipid inclusions in the
cells of the connective tissue and the development of adipose tissue. The stratified
epithelial corpuscles persist much longer.
If the body is stressed, involution is temporary, quick or accidental. When stressreactions occur the emission of T-lymphocytes into the blood and the mass destruction of
lymphocytes in the body itself, especially in the cortex take place. This involution may
occur due to different affects on the body of extremely strong stimuli (trauma, intoxication,
infection, starvation, etc.).
If the involution occurs, it leads to glucocorticoids deficiency of the adrenal cortex.
This leads to reduced resistance to infections and intoxications. Especially the risk of
appearance of tumors increases.
Thus, the thymus is an important organ in the human body and in violation of its
functions the resistance of a human body to viruses and infections is weakening.
MODERN ASPECTS OF A FACE TRANSPLANT
Babicheva E., Karapetyan E., Shishmaryova V. – the 3rd-year students
Scientific leader – Prof., Doc.Med.Sc. V.V. Grebenyuk
Face transplant has already stopped being the transaction available only to characters
of fantastic movies. Plastic surgery reached improbable heights. Now doctors can sew the
ends of nervous fibers thanks to that people get their new ears, noses, tongues and other
organs which are successfully performing the functions in the found body.
Transplant surgery is an operation during which a patient by means of the method of
transplanting receives an entirely new face.
The first-ever face transplant surgery was performed in France in 2005 for a woman
aged 38 years. Surgery was performed successfully. Now on her face a long scar and partial
deformation of the right cheek are still noted.
In general in the world about 20 face transplants, mostly in the USA and in France
were performed. To transplant a face more than ten doctors and nurses are required, a
surgery is being performed for 24-36 hours. In Russia face transplant is impossible because
189
of the law "About Organ Transplantation and (or) Tissues of the Person". It permits to
change fabrics only of one type while the human face is the whole complex of fabrics. The
patient who endured a face transplant won't look completely like the donor. The shape of
skull and facial muscles which are unique for each person will emphasize the difference.
For this reason the transplant face won't be similar to the donor`s one.
Face transact begins with the search for a donor having a similar genetic code. A face
is taken from a dead man. The resuscitators who fix death cause a crew of specialists. A
forensic scientist and a doctor on duty pronounce death. If from the legal point of view
there are no problems and there is an availability of a consent of relatives to transplantation,
the face is withdrawn and delivered to the place of surgery.
Before transplanting the new face to a patient an integument, muscular and fatty
tissue, cartilages of a nose and ears will be removed alternately. Then a surgeon in the
reverse order will replace the donor material, sewing some details, some pasting,
processing a part of them with a special laser.
The most famous cases of successful face transplant:
-In 2006, a resident of China, survived a fight with a bear, got a new right side of his
face from a man who died in a car accident.
-In 2007, the doctors saved a patient suffering from tumor. He received the face
transplant, and he got normal mouth, nose and throat.
-In 2010, In Spain a face transplant was performed for a man who due to a gunshot
injury was missing the lower half of the face. A week later stubble on man`s face started
growing back.
-In 2011, 25-year-old American received a complete face transplant after severe
burns.
ADVANCES IN CLINICAL USE OF UMBILICAL CORD STEM CELLS
Yakimenko S. – the 2nd-year student
Scientific leader – Cand.Med.Sc. T.L. Ogorodnikova
Stem-progenitor cells are cells which are capable of unlimited proliferation and
regeneration into absolutely any cells. From stem cells such cells as cells of bones, muscles,
blood cells and cells of skin can be obtained. 100 ml of cord blood contains the same
number of hematopoietic stem cells as generally a liter of the bone marrow has. The
procedure of collecting umbilical cord blood is completely safe for both mother and child,
painless; it can be carried out at the natural childbirth and during caesarean section and it
is simple.
After administration of stem cells an infarct area is reduced by 29%. Stem cells restore
the damaged heart tissue prescription of up to 8.5 years. Umbilical cord stem cells have a
protective effect on neurons. There are successful results of the 10-year study on the
effectiveness of immunosupressive therapy and hematopoietic stem cell transplantation in
the treatment of multiple sclerosis, in the treatment of cerebral palsy and other diseases of
the nervous system in children. Preparation of lung tissue stem cells can be used in
regenerative therapy of respiratory diseases: emphysema, chronic bronchitis, asthma, lung
fibrosis. Transplantation of umbilical cord stem cells is used in autoimmune intestinal
diseases (Crohn's disease, nonspecific ulcerative colitis). Many studies show the
effectiveness of stem cells in the treatment of liver cirrhosis. As a result of the use of stem
cells the majority of patients had regression of diabetes and stopped to use insulin. Stem
cells are used in the treatment of congenital defects of vision, retinitis pigmentosa, optic
190
atrophy, retinal degeneration, eye burns. In dentistry a tooth germ, the same as in the
embryo, is grown and implanted into the gums. Two months later a new tooth will take
roots and erupt. Determination of osteogenic potential of stem cells of these cells showed
that 500 mg of mesenchymal stem cells may form 3 kg of bony tissue.
It is possible that the stem cells will help in the treatment of such diseases as blood
diseases: lymphoma, hemoglobinuria, and refractory aplastic anemia, sickle cell anemia,
paroxysmal nocturnal hemoglobinuria, acute and chronic leukemia, Fanconi anemia,
macroglobulinemia, myelodysplasia; autoimmune diseases: rheumatoid arthritis,
Alzheimer's disease, systemic sclerosis, Parkinson's disease; cancer: neuroblastoma,
cancer (breast, kidney, ovarian, testicular), small cell lung cancer, Ewing's sarcoma,
rhabdomyosarcoma, brain tumors and other congenital and acquired diseases: with
metabolic disorders, immunodeficiency, muscular dystrophy, liver cirrhosis , AIDS,
histiocytosis, amyloidosis.
Delayed immune recovery after umbilical cord transplantation is one of the most serious
obstacles to the widespread use of umbilical cord transplantation. The future of stem cell
transplantation is the following: the combined advances in chemotherapy and
immunotherapy to increase the survival of stem cells and reduce morbidity.
INTESTINAL DISEASES IN PRIMORYE
Viktorskiy V., Kabar M. - 2nd-year students
Scientific leader – Assoc.Prof. L.A. Guba
According to the 2015 data when registering multiple foci of AII (acute intestinal infection)
infections of viral etiology accounted for 82.6 %, 2014 - 69.2%. Collectively, for the first
half of 2016 the epidemic situation of acute intestinal infections is registered as not well
due to the high incidence of AII of viral etiology. It is the infection rate, which exceeds the
long-term annual average rate by 2.9% and it is above the level of 2015 by 1.5%.
According to an analysis the highest indices rates belonged to Salmonella – 1328 cases
(755,9 per 100,000 of population), group D Salmonella having accounted for 88.6% and
group B Salmonella -8.2%, group C - 3.1 % other – 0.1 %.
Dynamics of incidence of salmonellosis in all groups during 2004-2014
Groups
2004 2005 2006 2007
35
73 113
95
All
residents 20.26 42.24 64.04 56.37
35
73
45
43
Adults
over 18
20.26 42.24 31.49 31.71
0
0
68
52
People
under 17
202.8 157.8
years
35
73 113
95
Urban
residents 20.26 42.24 64.04 56.37
0
0
0
0
Rural
people
2008 2009 2010 2011 2012 2013 2014 Total
139
72 165 113 216 187 120 1328
88.15 45.89 90.40 62.95 118.2 102.2 65.21 755.9
63
36
84
54 100
66
58 657
50.37 28.71 56.99 36.99 67.% 44.97 39.62 451.3
76
36
81
59 116 121
62 671
1939.
233.1 114.4 230.7 176.1 325.2 334.6 164,9
5
138
65 136
% 203 173 115 1242
87.51 41.43 87.71 62,28 128.8 109.7 72.25 772.6
1
7
29
17
13
14
5
86
105.6 67.03 51.68 55.48 20.13
Analysis of longitudinal dynamics of morbidity of viral hepatitis A showed a
tendency to decrease – the average rate of decline amounted to 40.8%.
191
Incidence of VHA (viral hepatitis A) in groups during 2004-2014
Groups
All
residents
Adults
aged 18
and over
People
under 17
years
Urban
residents
Rural
people
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Total
179
56
17
2
8
8
3
2
1
2
3 281
103.6 32.40 9.63 1.19 5.07 5.10 1,64 1.11 0.55 1.09 1.63 163.0
179
56
8
2
2
2
3
1
2
1 256
103.6 32.40 5,60 1.48 1.60 1.59 2.04 0.68
0
0
9
0
26,84
6
6
0
18,40 19.06
1
1.36 0,68 151.0
1
0
2,98 2.80
2
25
5,32 75.41
179
56
17
2
8
8
3
2
1
2
2 280
103.6 32.40 9.63 1.19 5.07 5.10 1.93 1.30 0.63 1.27 1.26 163.4
0
0
0
0
0
0
0
0
0
0
1
1
4,03 4,03
Analysis of longitudinal dynamics of AII morbidity caused by rotavirus infection
showed a strong tendency to growth ‒ the average growth rate amounted to 18.5%. In the
structure of cases child population predominates (99.7 percent). The adult population is
0.3%.
Dynamics of AII morbidity caused by rotavirus infection in populations during
2004-2014
Groups
All
residents
Adults
aged 18
and over
People
under 17
years
Urban
residents
Rural
people
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 total
0
0
0
0
17 267 120
93 141 151
75 864
0.00 0.00 0.00 0.00 10.78 170.2 65.75 51.81 77.13 82.54 40,76 499.0
0
0
0
0
0
1
0
0
0
0
1
2
0.00 0.00 0.00 0.00 0.00 0.80 0.00 0.00 0.00 0.00 0.68 1.48
0
0
0
0
17
266
120
93
141
151
74
0.00 0.00 0.00 0.00 52.14 845.0 341.8 277.6 395.3 417.5 196.8
0
0
0
0
17 242 104
78 127 140
71
0.00 0.00 0.00 0.00 10.78 154.3 67.08 50.60 80.56 88.77 44.61
0
0
0
0
0
25
16
15
14
11
4
0.00 0.00 0.00 0.00 0.00
- 58.25 59.15 55.65 43.59 16.10
862
2526.
1
779
496.7
85
-
EXCHANGE OF TYROSINE
Sat M., Lobanova N. – the 2nd-year students
Scientific leaders – Assoc. Prof. L.Ya. Etmanova, Cand. Ped. Sc. I.A. Bibik
Phenylalanine is an essential amino acid. It is used in the body only in 2 processes:
working as a substrate for protein synthesis and in the process of converting into tyrosine.
192
About 90% of phenylalanine is converted into tyrosine: conversion of phenylalanine to
tyrosine is a first response of phenylalanine metabolic pathway. All further transformations
taking place in the body are connected with tyrosine.
In violation of transformation of phenylalanine into tyrosine a disorder phenylketonuria (phenylpyruvate oligiphrenia) occurs.
Due to the impossibility of conversion of phenylalanine to tyrosine, phenylalanine
catabolism proceeds involving an alternate path, the content of phenylalanine and
metabolites of alternate pathway (phenylpyruvate, fenillaktata, fenilatsetatai and ets.)
increasing in the blood and urina.
Symptoms: Sharp violation of the mental and physical development, convulsive
disorder, "mouse" smell as well as violation of skin pigmentation occur.
When phenylalanine and its derivatives exceed, they have toxic effects on brain cells as
they limit tyrosine and tryptophan transport across the blood-brain barrier and inhibit the
synthesis of neurotransmitters (dopamine, norepinephrine, serotonin). Without treatment
patients with PKU won’t live to 30 years. The disease is inherited according to an
autosomal recessive pattern. There are 2 forms of phenylketonuria:
1. Classical phenylketonuria:
The reason: a hereditary defect of the enzyme called phenylalanine hydroxylase.
The frequency of the disease: 1 in 10,000 infants.
2. Variant phenylketonuria (cofactor-depending, hyperphenylalaninemia):
Reason: mutations in genes that control metabolism of H4-biopterin.
The incidence: 1-2 cases per 1 million of newborns.
In this form of the disease there are severe neurological damages and early deaths.
Treatment of phenylketonuria: a diet with almost total exclusion of phenylalanine from
the food.
To diagnose phenylketonuria determination of the concentration of phenylalanine and
abnormal metabolites in the blood and urine of a patient is needed.
In hereditary gene defect of enzyme of dioxygenase (homogentisic acid) Alkaptonuria
("black urine" disease) occurs. In this disease a large amount of homogentisic acid is
excreted with the urine.
With its air oxidation by O2 alkaptons are formed - dark pigments.
Symptoms: 1. The urine becomes black.
2. Ochronosis - black spots in the cartilages. (On the tip of the nose and in the earlobes);
The incidence: 2-5 cases per 1 million of newborns.
The disease is inherited according to an autosomal recessive pattern.
VIDEO GAME ADDICTION
Karyakin M, Egorov K. – the 4th-year students
Scientific leader – N.G. Brash
Video game addiction is a form of psychological dependence, which manifests itself
in obsessive fascination with video games and computer games. A man obsessed with
computer games, begins to confuse reality with the virtual world. In severe cases,
cyberspace becomes the main medium of existence. On the symptomatology the game
addiction is similar to alcoholism and narcomania. Computer game dependence erases
personal features, the person ceases to exist, and virtual existence of a character dominates.
A person with computer game dependence becomes "a disabled person" socially, thinking
gains autistic character. The fact is that there is no medication for the treatment of the game
193
dependence. And it is a real problem. Therefore a series of medical institutions and
programs performing treatment for the game dependence and paying attention to the
prophylaxis appeared. Their aim is not to give access to games during a certain time, and
also to slow the Internet gradually that may lead to the impossibility of the process of
playing.
STATISTICS OF DIABETES TYPE I IN CHILDREN IN THE CITY OF
BLAGOVESCHENSK
Parshakov D., Sorokina E. - the 4th-year students
Scientific leader - Can.Med.Sc. O.A. Tanchenko
Today diabetes is one of the leading medical and social problems. Millions of people
worldwide suffer from this disease. Despite intensive research, diabetes mellitus is a
chronic disease that requires ongoing monitoring to prevent complications and premature
disability.
We are interested in this problem, and we decided to analyze the incidence of type
1 diabetes in children and teenagers of Blagoveschensk. According to the hospital archives
the highest percentage of the incidence of type 1 diabetes (T1D) among the children aged
0-14, which was registered in 2015, is 0.09% per 41740 individuals and among aged 1517 years, which was registered in 2013, is 0.33% per 8374 individuals. The maximum
number of type 1 diabetics among the children with disabilities aged 0-14 years, which was
registered in 2014, is 0.08% per 39931 individuals. Among the teenagers aged 15-17 years
the peak of incidence, which was revealed in 2013, is 0.26% per 8374 individuals.
Thus, diabetes is a global problem, which is growing every year. According to the
statistics, diabetes is now a disease that affects 371 million people worldwide; it is 7% of
the world population.
POSTPARTUM DEPRESSION
Lobanova E., Poh V. - the 4th-year students
Scientific leader - N.G. Brash
Postpartum depression is a violation of the psycho-emotional sphere, which occurs in
postpartum period and is characterized by marked deterioration in mood.
The relevance of this topic is due to the high prevalence of this disorder which occurs
in 10-15% of women who gave birth.
Currently, the so-called polyetiological hypothesis of any depression, including
postpartum is most justified. There are three main factors: heredity, psychological trauma
and somatic disorders. According to this hypothesis, the combination of the mentioned
factors is considered to play a significant role in the development of depressed state.
Typically, postpartum depression is a slight and temporary conduct disorder, which
occurs on the third or fourth day after birth and reaches its climax on the fourth or fifth
day. The most common symptom of postpartum depression is crying for no reason. Also
not ruled out sudden energy and love for others, which are replaced by melancholy and
despair. Other symptoms are mild irritability, anger and hostility, chronic headaches, a
feeling of unreality, exhaustion and devastation, as well as the relentless anxiety. The list
of symptoms also includes sleep disorders - irreplaceable companions of women in the
postpartum depression.
194
The manifestations of postpartum depression should be treated very seriously. Its
timely identification will allow us to take appropriate measures, which will effect both on
the health of a newborn and a mother herself.
There are two treatment landscapes: psychotherapy and medication-assisted
treatment. The best option is the use of psychotherapeutic approach, and in most cases,
psychotherapy shows good, positive results. Medicines are used in cases when the severity
of depression is significant or therapy is not effective enough.
VASCULAR DEMENTIA
Poh V., Lobanova E. - the 4th-year students
Scientific leader - Doc.Med.Sc. V.N. Karnaukh
The problem of dementia is one of the most significant health and socio-economic
problems of the present time, as the disease is not only impairs the quality of life of patients,
but also leads to large economic losses. Vascular lesions of the brain are considered to be
the second most common cause of dementia in the elderly (about 20% of all dementias).
Vascular dementia (VD) is a cognitive decline as a result of ischemic or hemorrhagic
brain damage due to chronic pathologies or cerebral stroke. To diagnose dementia it is
necessary to conduct neurodevelopmental testing. Diagnosis of VD is based on three
criteria: 1) the presence of dementia (psychodiagnostic testing); 2) the presence of
cerebrovascular disease, which has been confirmed by clinical, biochemical data as well
as results of a Doppler ultrasonography test of the blood vessels of the brain, CT data,
findings on MRI scan of the brain; 3) feedback based on 1 and 2 criteria.
The leading role in the formation of vascular dementia in the brain lesions plays the
damage of the white matter of the brain and basal ganglia, thalamus, leading to
communication disorders in the frontal areas and subcortical structures. The main
pathogenic factor in the development of this phenomenon is hypertension, which leads to
changes in the vessel wall, thereby developing arteriolosclerosis. This vascular pathology
leads to a decreased perfusion, the occurrence of ischemic white matter in the brain and
development of multiple lacunar infarcts. As a result of their cumulative effect a loss of
brain tissue, which results in brain atrophy take place. In patients with vascular dementia
lifetime characteristic changes in the brain are detected using modern methods of
neuroimaging.
A feature of vascular dementia is the variety of clinical disorders, and often a
combination of several neurological and neuropsychological syndromes in a patient.
Patients with vascular dementia are characterized by a slowdown, rigidity of the mental
processes and their lability, a narrow range of interests. In patients with marked cognitive
decline and difficulties in carrying out the functions of activities of daily living, the loss of
social skills, and adequate assessment of the disease. Firstly, among the cognitive deficits,
memory and attention disorders, which are marked at the stage of initial vascular dementia
and have been steadily progressing, are noted. In the later stages disorders of abstract
thinking and judgment may develop. Most often there are signs of semantic aphasia and
amnestic forms. More than half of patients with vascular dementia have the so-called
“emotional incontinence” and some patients have depression. The development of mood
disorders, psychotic symptoms are possible. In addition to cognitive impairment patients
with vascular dementia have neurological manifestations such as pyramidal, subcortical,
pseudobulbar, cerebellar syndromes, paresis of muscles of the limbs – more often not rough
as well as gait disturbance by apraxia-ataxia type or parkinsonian type. In most patients,
195
especially the elderly, there are violations of control of the pelvic functions. Often
paroxysmal states such as falls, seizures, syncopal states are noted. It is the combination of
cognitive and neurological disorders that let us differ vascular dementia from Alzheimer's
disease.
Treatment of vascular dementia should include interventions aimed at the underlying
disease, against which it develops, basic therapy, correction of the major syndromes,
effects on cerebral hemodynamics, metabolic therapy.
PSYCHOEMOTIONAL LEVEL CHANGE IN THE 5th-YEAR STUDENTS
DURING TAKING STANDARDIZED IMITATIONAL MODULE
Kozhechenkov K. – the 5th-year student
Scientific adviser – Assoc.Prof., Cand.Med.Sc. O.S. Yutkina
It is not a secret that in order to become a successful doctor, you need to have a great
practical experience. Precisely in order to work out all the necessary skills and to develop
abilities without risks to a patient the Centers for simulation and certification are being
created. These are institutions carrying out testing and certification of students, residents,
graduate students and doctors using simulation training technologies. The basis of these
centers is made up of classes in various specialties and training that takes place with the
use of simulation equipment with different realism levels.
Despite the feeling of tension and sometimes even actual stress while working with
a virtual simulator, students prefer to see immediate results after treatment or manipulation,
rather than just reading about them in books or listening to lectures. The greatest value of
this method of learning is that students have the opportunity to make mistakes and learn
from them in a safe learning environment.
This article contains analysis of the studying methods of the psycho-emotional level
and tolerance to uncertainty in the 5th-year students while taking a standard simulation
module "Acute constrictive laryngotracheitis".
PHARMACOTHERAPY IN PULMONARY EDEMA
Egorov K. – the 4th-years student
Scientific leader - Can.Med.Sc. V.I. Tihanov
Acute heart failure can clinically be manifested by a pulmonary edema. The
pulmonary edema is subdivided into interstitial and alveolar. In case of the former liquid
does not come out into the alveoli, and in the latter comes out. The first state in clinical
practice is called cardiac asthma, and the second – fluid lungs. The cardiogenic pulmonary
edema arises because of poor contracting ability of a left ventricle. In the treatment of this
pathology it is necessary to prevent oxygen deficiency and to eliminate the foam from the
respiratory tracts (oxygen with ethanol vapors), to remove the liquid out of the lungs
(furosemidum), to decrease the load on the heart, pressure within the pulmonary
circulation and the peripheral resistance of the vessels (nitroglycerine), to eliminate a pain
syndrome (morphinum), to stop psychomotor exaltation (droperidolum), to normalize
cardiac emission (strophanthin).
FEATURES OF THE LOWER LIMB BONE STRUCTURE OF A NEWBORN
Chelombitko A., Malygina Yu. – the 1st-years students
Scientific leader – A.E. Pavlova
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A newborn pelvis is situated high, reaching the 3rd lumbar segment. The form of it
reminds a narrow and high funnel. The wings of the iliac bone are not expanded. The
sacropromotory is not expressed. The sagittal diameter of the pelvic cavity prevails over
the transverse diameter. The sexual differences of the pelvis are already marked in the
intra-uterine
period.
A feature of the pelvic bone of newborns is shallow depth of the coxal cavity that leads to
the increased mobility of the hip joint. Free newborn’s lower limbs are in a bent position
and can not be straightened. It happens due to a short length of the muscles, especially the
tendons, which seem to tighten the limbs.
The femur of newborns is short and relatively thick, curled stronger than that of an
adult, making it easier to bring the bent legs to the trunk. A neonatal foot is flat and it is in
the supine position. The arch of a foot is formed during the first two years of life due to the
development of its support function and strengthening of the ligamentous apparatus.
DIABETES COMPLICATIONS
Mikhailov P. - the 5th-year student
Scientific leader - Assoc. Prof. O.A. Tanchenko
All forms of diabetes increase the risk of long-term complications. They usually
develop after 10 to 20 years, but may be the first symptoms in those who have otherwise
not received a diagnosis before that time.
The major long-term complications relate to damage to blood vessels. Diabetes
doubles the risk of cardiovascular disease and about 75% of deaths in diabetics are due to
coronary artery disease. Other "macrovascular" diseases are stroke, and peripheral
vascular disease.
The primary complications of diabetes due to damage in small blood vessels include
damage to the eyes, kidneys, and nerves. Damage to the eyes, known as diabetic
retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can result
in gradual vision loss and blindness. Damage to the kidneys, known as diabetic
nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney
disease, sometimes requiring dialysis or kidney transplant. Damage to the nerves of the
body, known as diabetic neuropathy, is the most common complication in diabetes. The
symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead
to damage to the skin. Diabetes-related foot problems (such as diabetic foot ulcers) may
occur, and can be difficult to treat, occasionally requiring amputation.
Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness.
There is a link between cognitive deficit and diabetes. Compared to those without
diabetes, those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive
function.
PSEUDOMEMBRANOUS COLITIS
Mikhailov P. - the 5th-year student
Scientific leader - P.K. Soldatkin
C.difficile is a strictly anaerobic gram-positive spore-forming bacterium that is a part
of the normal residual intestinal microflora. The appearance of pseudomembranous colitis
is the result of a variety of predisposing factors, such as antibiotic therapy or surgery.
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In milder forms of diarrhea and cramping abdominal pain is observed. Stools are
copious, watery, with mucus. General toxicity manifests as fever, weakness, fatigue,
headache, nausea and vomiting. All symptoms disappear after the abolition of antibiotics.
In moderate and severe forms, patients are suffering from debilitating diarrhea. In the stools
of patients an admixture of mucus and blood are revealed. Dehydration and
demineralization are developing. Convulsions are also possible.
During the height of the disease leukocytosis, neutrophilia and ESR acceleration are
being marked in the blood. In moderate and severe forms the following is observed:
hypoproteinemia, hypoalbuminemia, hypokalemia, and in the terminal stages may be
azotemia. Charcot-Leyden crystals might be found in the stools.
In endoscopy there are plaques (membranes) with a diameter of 0.2-1.5 cm, densely
welded into the mucous; when you try to remove them blood appears.
PMC Treatments include: etiotropic therapy, sorption therapy, intestinal microbial
ecosystem restoration; elimination of dehydration and correction of violations of waterelectrolyte balance.
FEATURES OF CLINICAL PROGRESSION OF RARE FORMS OF
ERYSIPELAS
Shpinyov A. – the 5th-year student
Scientific leader - T.A. Dolgih
Erysipelas - (Polish “roza” - rose) - anthroponotic infectious disease caused by
a B - hemolytic streptococcus group A, occurring in the acute (primary) or chronic
(recurrent) form with the expressed intoxication syndrome, skin manifestations and
lymphadenitis.
According to statistics, currently the incidence of erysipelas in the European
part of Russia is 150-200 per 10,000. In recent years there has been the rise of the
incidence in the United States and some European countries. The majority of
patients are those aged 50 years and older (up to 60-70% of all cases). It should be
stressed that the mortality rate of newborns from erysipelas is extremely high.
Erysipelas is dangerous for children in the first year of life as well.
The incubation period lasts from a few hours to 3-5 days. The disease begins
with headache, general weakness, fever, myalgia, nausea and vomiting (25-30% of
patients). During the first hours the temperature increases up to 38-40 ° C. After 12 days, symptoms of the disease are at their peak.
The severity of intoxication and the prevalence of the local process are
considered to be the criteria of the severity of erysipelas.
PECULIARITIES OF CLINICAL COURSE OF HAEMOPHILIC MENINGITIS
IN CHILDREN
Pakhomov S. – the 5th year student
Scientific leaders - T.A. Dolgih, O.I.Katina
Haemophilic meningitis – is an acute anthroponosis infectious disease with aerosol
mechanism of transmission. It is characterized by a primary lesion of the respiratory tract
and the brain membranes.
The urgency of the problem of haemophilic meningitis is due to the fact that this
pathology takes the second place in the structure of bacterial meningitis in children under
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5 years. There is often a long and undulating course of the disease and a high incidence of
residual effects and adverse effects, such as the progression of hydrocephalic-hypertensive
syndrome and hearing loss. Certain value has a relatively late appearance of meningeal
syndrome leading to diagnostic difficulties and frequent hospitalization in non-core
hospitals.
The causative agent - is the bacterium Haemophilus influenzae type of Haemophilus
(Pasteurellaceae family). The sources of infection – are patients with any clinical form of
Hib-infection, as well as healthy carriers. Susceptibility is due to the lack of human
immunity and the anatomical and physiological characteristics of children under 5 years.
Haemophilic meningitis develops most often on the burdened premorbid
background: organic CNS lesions - 42.7%, frequent acute respiratory diseases - 34.8%,
pathology of pregnancy and childbirth - 20.3%. The disease begins subacute: a cough,
runny nose, and increase of body temperature to 38-39 ° C. In some patients in the initial
period dyspepsia may dominate. This period lasts from several hours to 2-4 days. Then the
child's condition worsens: enhanced intoxication syndrome, disorders of consciousness,
convulsions, and in 1-2 days - focal symptoms, body temperature reaches 39-41 ° C,
increasing headache, vomiting, meningeal symptoms. Fever in Haemophilic meningitis is
often remittent or irregular. It is registered even on the background of antibacterial therapy,
the average duration 10-14 days. Catarrhal symptoms in the form of pharyngitis are noted
in more than 80% of patients. Often there is hepatosplenomegaly, lack of appetite,
confusion of consciousness, weakness. Focal neurological symptoms are seen at least in
50% of patients. Often there is paresis of cranial nerves, hearing impairment, focal seizures,
ataxia, muscle tone disorders for extrapyramidal type, rarely paresis of the extremities.
Meningeal syndrome (e.g. protrusion of cerebellum) and hanging symptom are expressed
moderately. Neck stiffness of muscles is usually typical for children older than 1 year. And
Brudzinsky and Kernig symptoms in some patients are mild or absent.
The most accurate diagnosis is to identify the causative agent from blood and CSF
during bacteriological examination, RAL and PCR.
Drugs of choice for the treatment of Haemophilic meningitis are Ceftriaxone and
Meronem. In the absence of the effect fluoroquinolones of the second generation
(Pefloxacin, Ciprofloxacin, Ofloxacin) or a combination of cephalosporin (Ceftriaxone)
and fluoroquinolones are administered.
Thus, considering the prolonged and sinuous course of the disease, a high risk of
residual effects and adverse effects, it is necessary to pay more attention to timely
vaccination of the disease.
DENTAL SYSYEM
Sholokhova I. - the 2nd-year student
Scientific leaders – Assoc.Prof. S.S. Selivyorstov, Cand.Ped.Sc. I.A. Bibik
Dental system is a complex functional system that combines functional subsystems
such as teeth, periodontium, jaws, muscles, joints, salivary glands.
This subject is very topical today, as there are many people who suffer from dental
diseases.
Diseases of the dental system are very diverse and numerous. The most common are
diseases of dental hard tissues (caries and some non-carious lesions)
Caries (tooth decay) is a pathological process manifesting in demineralization and
progressive destruction of the hard tooth tissue with formation of a defect in the form of a
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cavity. This is one of the most common lesions of the teeth, which, according to WHO,
affecting up to 90% of the world population.
Non-carious lesions of the dental hard tissues are associated with wedge-shaped
defects, fluorosis, dental erosion and acid necrosis.
Wedge-shaped defects are defects of the hard dental tissues, which are located on the
vestibular surface of the teeth, usually canines and premolars.
Fluorosis (hyperfluorosis, mottling of enamel) is a disease that develops in prolonged
and excessive fluorine entering the body and accompanied not only by dental injury, but
also by damage of many organs.
Dental erosion is the progressive decline of the cup-shaped enamel and dentin on the
buccal surface of the first incisors, and then canines and premolars of the upper jaw.
Acid necrosis of the dental hard tissue is an occupational disease occurring in people
working in the field of inorganic acids production.
Along with the damage of the hard tooth tissue at the age of 18 to 25 years most
common are diseases associated with the appearance of the third molar.
The third molar is the 8th and last tooth in the row (colloquial name - "the eighth"). It
usually erupts between the age of 18-25 years (sometimes later, sometimes earlier,
sometimes doesn’t erupt).
Thus, dental diseases are very common. The teeth should be treated as they fulfill the
primary function of food processing. And if it is broken, the process of digestion will be
disturbed.
APPLES ARE A PANTRY OF HEALTH
Mitrofanova T. - 1st-year student
Scientific leaders – A.F. Sapyanova, Cand.Ped.Sc. I.A. Bibik
Vitamins are group of low-molecular substances of manifold nature. They are required for
biochemical reactions providing growth, survival and reproduction of an organism.
Usually, vitamins play the role of co-enzymes - molecules, which take part in the work of
enzymes. Vitamins are called the flame of life, because life without them is impossible.
Apples are a valuable natural source of vitamins. They contain rich complex of vitamins
(e.g. A,B,C,D, etc.), broad spectrum of minerals (e.g Ca, Mn, Mg, Zn, F, Fe), of course,
nutritious and health-giving substances (e.g antioxidants, pectins, organic acids, sugar and
cellular tissue), which are needed for an organism of a man, particularly in winter
Experience of doctors and clinical supervisions indicate the existence of series of specific
diseases, which appear because of defects of nutrition. Experiences of participants of the
long travels are evidence in favor of it. For example, scurvy was a terrible whip for sailors
for a long time. The number of people died of scurvy was bigger than from wars.
Despite the fact that requirement daily intake of vitamins is milligrams and micrograms,
an organism of a man or animal must get vitamins every day, because it can't synthesize
vitamins itself or synthesize them in small quantity, so we (or animals) get them with food.
Vitamins are assimilated by organism, forming different compounds (e.g etheric, amide,
nucleotide etc). Many vitamins can unite with proteins and then they form enzymes typical biological contact substances, which promote quick current of reactions of
synthesis, breakage and restructuring. Because of that we can say that apples are
irreplaceable products in a diet of every person
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BATTLE OF THE CENTURY: CRISPR / Cas9 vs HIV
Leonov D., Ustinov E. –the 1st-year students
Scientific leaders – Assoc.Prof. E.N. Gordienko, Cand.Ped.Sc. I.A. Bibik
HIV is a causative agent of acquired immunodeficiency syndrome (AIDS) - related
to the Lentivirus genus of the Retroviridae family whose genome is represented by two
copies of single-stranded RNA, wherein the two ends are long terminal repeats.
Even 5 years ago, no one could believe that there will be such a revolutionary
approach to the treatment for diseases. The furore in the world of science has made the
system of clustered regularly interspaced short palindromic repeats CRISPR / Cas9. The
system was discovered almost thirty years ago in bacteria and then in archaea. In the
genome of microorganisms repetitive DNA segments (20-50 nucleotides in length) were
found. Genes of various proteins, cutting and splicing DNA (cas genes) were in close
proximity to these repeats. Genetic analysis has shown that these unique regions of DNA
are homologous to different DNA sites (protospacers) of bacteriophages and plasmids - the
enemies of bacteria. Moreover, with the corresponding spacer a bacterium becomes
resistant to the penetration of a foreign DNA. Thus, it was shown that CRISPR / Cas system
is a kind of bacterial "immunity" system.
In 2014, such research was conducted by American scientists on microglial cells,
macrophages and monocytes, having confirmed the success of this therapy. In addition, the
scientists were able to immunize cells against HIV: they made the cells keep CRISPR /
Cas9 system with an appropriate RNA directed against HIV (i.e. integrated into the
genome) constantly. The cells were not disturbed, and after it HIV infection, integration
into the genome and virus replication didn’t occur in them.
The proposed system of gene alteration is not as wonderful as it might seem at first
glance. One main problem of this method is its effectiveness. Often, the work over the
targeted change in one site requires a lot of time and money, but does not lead to a 100%
result: not all the targets can be found and altered. Another problem is the correction of
other DNA segments, similar to those with the desired order, or so-called off-target-effects
which may affect the gene, even if we do not want to change it. And finally there is a
problem of delivery of CRISPR / Cas9 system.
Thus, the rapidly developing gene therapy using the CRISPR / Cas9 is the key to
getting rid of HIV infection and associated diseases and complications. But it`s hard to
expect that such a medicine will appear on the shelves of pharmacies tomorrow. It is still
worth thinking about the ways to develop a truly effective and safe treatment.
HORMONAL CONTRACEPTIVES OF NEW GENERATION
Poh V., Lobanova E. - the 4th-year students
Scientific leader - Cand.Med.Sc. V.I. Tikhanov
According to the definition of WHO experts today means of hormonal contraception
are considered to be the most effective and highly reliable for prevention of undesirable
pregnancy. Therefore it is no wonder that according to WHO data more than 70 million
women use hormonal contraceptives.
Hormonal contraceptives prevent pregnancy by suppressing ovulation and increasing
the viscosity of vaginal mucus, which is released by the cervix that further prevents the
penetration of sperm into the uterus and, accordingly, the process of fertilization. They also
contribute to slowing down of peristalsis of the fallopian tubes.
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Modern hormonal contraceptives are differentiated according to the content of
hormones. They are divided into combined (composition contains estrogens and gestagens)
and noncombined (consisting of only gestagens). Combined, in turn, are divided into
monophasic (containing 21 tablet – a dose of estrogen and progestogen in each tablet is
stable) and the polyphase (with variable ratio of estrogen and progestogen - an estrogen
dose is almost stable in all 21 tablets, while the progestogen is administered in increasing
dosage, i.e. according to phases, being increased by the end of medication taking by a factor
of 2-3 times (phase 2 and phase 3 drugs).
Today, the most popular contraceptive drugs of the new generation are the following:
Yarina is a combined monophasic contraceptive next-generation dug - low-dose. The
underlying substance is drospirenone (a synthetic hormone with properties similar to
natural progesterone - a derivative of 17 a-spironolactone). Its pharmacological properties
are similar to endogenous progesterone, and it has gestagenic, antiandrogenic and
antimineralocorticoid effects.
Jeanine is a new monophasic preparation possessing antiandrogenic effect - low-dose.
In the women taking these drugs the establishment of a regular menstrual cycle, reducing
the number of painful menstruations, the intensity and duration of the bleeding are marked.
Besides, there are data of reducing the risk of ovarian cancer and endometrial cancer.
Regulon is a monophasic preparation of a new generation. It refers to low-dose birth
control pills. It is suitable for young nulliparous and parous women and for those who have
regular sex, as well as for women of late reproductive age.
HUNTINGTON`S CHOREA
Bayrak T., Bashtannik А. – the 3rd-year students
Scientific leader – Doc.Biol.Sc. N.A. Ishutina
Huntington's chorea is a hereditary neurodegenerative disease characterized by
gradual onset, usual onset age of 35-50, a combination of progressive trochaic hyperkinesis
and mental disorders (dementia). It was described by Huntington in 1872.
The disease is inherited according to an autosomal dominant pattern with high
penetrance. Men suffer from it more often.
Pathogenesis is the following: the evolving death of nerve cells with a pronounced
reduction in the content of neurotransmitters in the basal ganglia, the marked reduction of
mitochondrial respiratory chain activity in the caudate nucleus. Violations of dopamine
metabolism are not excluded. Grossly brain atrophy is detected. In the basal ganglia,
mainly in the shell and caudate nucleus, gross degenerative changes of both small and large
cells, a decrease in their numbers, and the proliferation of glial cells are determined.
The disease usually begins to manifest itself at the age of 30 years and older. The first
symptoms of the disorder can be intellectual disorders and then gradually dementia can
occur. At the same time there can be trochaic hyperkinesis: rapid, spasmodic, erratic
movements in different muscle groups. Implementation of voluntary movements is
hampered due to hyperkinesis, and it is accompanied by a number of unnecessary
movements. However, even when hyperkinesis is expressed, especially early in the disease
process, they can consciously suppress hyperkinesis. To speak is difficult and the process
is also accompanied by excessive movements. Muscle tone is reduced.
It can be difficult to make a diagnosis in atypical cases of Huntington's chorea. The
family nature of disease, identification of other focal symptoms of brain damage, the
character of the course of disease, some changes in the cerebrospinal fluid and other
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diagnostic criteria are of great importance. In using computerized tomography scanner the
signs of cortical atrophy are revealed. On the basis of studies of sensitivity of the blood
lymphocytes to X-rays there are instructions of possible early, pre-clinical, diagnosis of the
disease.
It is necessary to distinguish Huntington's chorea from trochaic syndrome appearing
in brain tumors, syphilis, encephalitis, Alzheimer's disease, vascular disease, as well as
age-related (senile) atherosclerotic chorea.
Specific treatment is not available. To treat hyperkinesias the dopamine antagonists
are administered: Haloperidolum 1 mg twice a day, with increasing doses every 3-4 days
until a therapeutic effect.
CEPHALOSPORINS
Obvintseva A., Bitkivskaya A. – the 4th-year students
Scientific leader – Cand.Med.Sc. V.I.Tikhanov
Cephalosporins are a class of β-lactam antibiotics based on 7-aminocephalosporanic acid
(7-ACA). The main features of cephalosporins are great resistance to β lactamases enzymes produced by microorganisms.
Cephalosporins have bactericidal effect. The mechanism of this action is associated with
damage of bacteria cell membranes (suppression of peptidoglycan synthesis) which are in
the stage of reproduction, and release of autolytic enzymes, that leads to their death.
There are 5 generations of cephalosporins, depending on their antibacterial activity.
The preparations of the 5th generation.
Ceftobiprole (Zeftera) is a drug, a semisynthetic antibiotic cephalosporin of the Vth
generation, of broad-spectrum for parenteral administration.
Indications: Treatment of complicated infections of the skin, including infected diabetic
foot without concomitant osteomyelitis.
Contraindications: hypersensitivity to ceftobiprole, any auxiliary substance of the drug and
other cephalosporins. Patients who have allergic reaction to beta-lactam antibiotics.
Children under 18 years old.
Side effects: nausea, vomit, diarrhea, dyspepsia; fungal infection of the mouth and skin;
hives, itchy rash and drug hypersensitivity, pruritus, dizziness, headache, dysgeusia;
hyponatremia; increased levels of liver enzymes; skin reactions at the infusion site.
Pharmacological properties:
It has bactericidal activity against a broad spectrum of gram-positive bacteria, including
methicillin-resistant species of Staphylococcus, penicillin-resistant Streptococcus
pneumoniae, and ampicillin-sensitive Enterococcus faecalis. Ceftobiprole is also active
against many gram-negative bacteria, including many strains of the family Enterobacter
spp. and Pseudomonas aeruginosa.
Ceftobiprole is associated with many essential penicillin binding proteins (PBPs) both
gram-positive and gram-negative bacteria. Ceftobiprole has a bactericidal activity against
Staphylococcus spp., which are resistant to methicillin, caused by binding with
staphylococcus PBP2a, including methicillin-resistant Staphylococcus aureus.
Ceftobiprole is resistant to hydrolysis by penicillines Staphylococcus aureus and by many
beta-lactamases of class C and class A produced by gram-negative bacteria. Like most
cephalosporins ceftobiprole hydrolyses by beta-lactamases of broad-spectrum,
carbapenemases and metallo-beta-lactamases. In vitro selection of high-level resistance to
staphylococci, streptococci, and Haemophilus influenza wasn’t observed.
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Dosage and administration:
For infections that are caused by Gram-negative bacteria and Gram-positive bacteria with
an infected diabetic foot without concomitant osteomyelitis, the recommended dose of the
drug Zeftera is 500 mg. every 8 hours.
In infections caused by Gram-positive bacteria the dose is 500 mg. every 12 h. This dosage
regimen wasn’t studied in patients with infected diabetic foot.
For patients with severe renal function a dose of ceftobiprole should be 250 mg. «Zeftera»
should be prescribed with caution for patients with severe renal insufficiency.
Conclusion.
Cephalosporin antibiotics have been used in clinical practice since 60s. During this period
more than 50 drugs of this group were synthesized. Today cephalosporins are occupying a
leading position in the treatment of nosocomial infections of various localization. A broadspectrum of antibacterial activity, good pharmacokinetic characteristics, low toxicity, good
compatibility with other antibacterial agents do cephalosporins the drags of choice for
many infections.
SIDE EFFECTS OF TRANQUILIZER
Naumovа D., Chermyanina N. - the 4th year students
Scientific leaders - Ph.D. Simon N.V., Katina O.I.
Various anxiety-phobic syndromes of non-psychotic level are considered to be the
main aim for the use of tranquilizers. These syndromes may be both acute and chronic,
developing within the framework of the so-called borderline states. And the side effects,
occurring on the background of their use, are usually associated with the excess of the
pharmacological effects of these drugs (anxiolytic, sedative, muscle relaxant,
anticonvulsant effect).
The main side effects of tranquilizers include: 1. Hypersedation phenomena subjectively noted, daytime sleepiness, decreased level of consciousness, impaired
concentration, forgetfulness, etc. 2. Miorelaxation - general weakness and the weakness in
various groups of muscles. 3. "Behavioral toxicity" - objectively marked in
neuropsychological testing, and light impairments of cognitive and psychomotor skills are
manifested even at the minimum dosages. 4. "Paradoxical" reactions – increase in agitation
and aggression, sleep disturbance (usually disappear spontaneously or with dose
reduction). 5. Mental and physical dependence - occurs when long-term use (6-12 months
of continuous reception) and is manifested with phenomena similar to neurotic anxiety.
Do not forget that the tranquilizers freely penetrate the placental barrier and can depress
the respiratory activity of a child, as well as disrupt the proper development of a fetus. So
they are not recommended for use during pregnancy and lactation
BODY IMAGE DISORDER
Naumovа D., Chermyanina N. - the 4th year students
Scientific leaders - Brash N.G., Katina O.I.
Disorders of the body scheme are expressed in violation of the usual idea of the size
and shape of your body or parts of it, about their location or position of the body. For
example, it seems to the patient that his head became huge and does not fit not only on the
pillow but also in the room, his lower extremities start right from the head, and there is no
trunk. As a rule such modified impression of the shape, size and position of his own body
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or parts of it disappear under the vision control. The patient sees his body in the usual and
familiar form. But as soon as he closes his eyes, his head again becomes excessively large,
etc. Disorders of body scheme are often accompanied with metamorphopsia - distorted
perception of shapes of surrounding objects. Also, a distorted perception of surrounding
objects reflects in the fact that they seem to a sick person less or greater than their actual
size (micropsia, macropsia). Their number increases (poliopsia). They move (optical
allestesia) and fall on the patient, pressed into him, and are in the turbulent motion (optical
storm). Sometimes not only the size and shape of objects in a roughly modified form are
perceived, but and spatial relationships: it seems to the patient that the walls of the room
become close, crash, and fall on him. Or, on the contrary, the walls move apart, the floor
becomes wavy, and the space seems to sever. Metamorphopsia and related symptoms are
different from illusions by the adequacy. They differ from the hallucinations that in a
distorted way the patient still perceives actually existing things, and not what exists in
reality.
MODERN IDEAS ABOUT ALZHEIMER’S DISEASE
Naumova D., Chermyanina N. – the 4th year students
Scientific leaders – Cand. Med. Sc. Karnaukh A.I., Katina O.I.
Alzheimer’s disease is the most common of all degenerative diseases. It occurs in
the elderly. The loss of neurons is primarily in the associative areas of the frontal, temporal
and parietal cortex of both hemispheres. In addition to the disappearance of neurons there
is the deposition of amyloid in senile plaques and thickening of neurofibrillary structures
of degenerating neurons. There are cases when dementia resembles Alzheimer's disease by
the clinical picture and its course, but such great number of plaques and glomeruli is not
revealed. Blood supply of atrophied zone is reduced, but it may be the adaptation response
to the disappearance of neurons. The changes, characterizing Alzheimer's disease, are
found in Down syndrome more often. This is due to excessive production of amyloid
precursor protein encoded in the triple chromosome 21.
Dementia syndrome is the most accurate portrait of Alzheimer's disease. It begins
slowly, usually with memory impairment. As the disease progresses there is the violation
of other higher brain functions. Speech becomes halting, accompanied by difficulty in
finding words. Thinking is retarded. There are errors in counting. Visual-spatial
orientation is impaired. In the later stages of the disease the study of mental functions
reveals disorientation, amnesia, aphasia, apraxia and agnosia. Walking troubles are only in
the final stages of the disease; reflexes, sensitivity, hearing, sight, eye movement and other
functions of the brain stem remains in the normal range. As the disease progresses
involuntary grasping and sucking reflexes become more expressed. Step is shortened.
Moderate rigidity and slowness of movement is revealed.
OMPHALITIS
Dorozhkova E., Moiseenko A. – the 3rd year students
Scientific leaders – Ivanova E.P., Katina O.I.
Omphalitis - is a disease of newborns characterized by inflammation of the skin
and subcutaneous tissue in the area of umbilical wound.
The development of omphalitis is associated with the ingress of infection through
the unhealed umbilical wound. This can occur in case of neglect of hygienic norms and
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rules of newborn care and treatment of the umbilical wound. Most often the infection
occurs between 2 and 12 days of life.
Staphylococcus aureus and Escherichia coli are the most common causative agents
of omphalitis. The source of infection may be the skin of a baby, contaminated with urine,
stool, and pyogenic flora; the objects of care, the hands of the nursing staff.
There are several forms of omphalitis: simple, phlegmonous and necrotic.
Common symptoms of omphalitis: fever, crying, the child is restless or languid,
poor appetite, decrease in weight gain. Local manifestations: the discharge from the wound
is of different color, redness of the umbilical ring, swelling of the skin around the navel,
red stripes.
General treatment: antibiotics, vitamin therapy, in severe cases intravenous injection
of glucose is needed in order to reduce the intoxication, and medicines forcing the immune
system. Localc treatment: to remove the discharge and processing of umbilical wound with
antiseptic solutions, in case of purulent form the antibacterial ointments, wound drainage,
and excision of necrotic tissue are administered; physiotherapy.
In phlegmonous form the broad-spectrum antibiotics are injected intramuscularly
for 10-14 days. Great importance is the feeding with the breast milk. In necrotic form of
omphalitis the surgical intervention along with general treatment is required.
Serious complications may occur: the umbilical inflammation of the lymphatic
vessels, inflammation of the arteries and veins, inflammation of the intestines, peritonitis,
liver abscess, hematogenous osteomyelitis, and suppuration of the lungs that develops on
the background of sepsis.
After the birth of a child it is necessary to have a daily process of the umbilical
wound with a solution of hydrogen peroxide. Then the dry wound is treated with brilliant
green or alcohol (treatment frequency — 3-4 times per day).
PSEUDOMONAS AERUGINOSA AS THE CAUSATIVE
NOSOCOMIAL INFECTION
Repyeva E. - the 3rd year student
Scientific leaders - Cand.Med.Sc. A.V.Prokopenko, O.I. Katina
AGENT
OF
Pseudomonas infection is quite dangerous and aggressive, with a high frequency of
occurrence in the population. Up to 20% of or hospital-acquired or nosocominal infections
are caused by Pseudomonas aeruginosa. 35% of urinary tract infections as well as 25% of
purulent surgical processes are caused by this bacillus. A quarter of cases of primary
bacteremia are also caused by P. aeruginosa.
Pseudomonas aeruginosa is widespread in the environment. It is a regular inhabitant
of the intestines of humans and animals. It is found on the skin and mucous membranes.
This is a small mobile Gram negative rod. It does not form spores and capsules. This is an
obligate aerobe that grows on ordinary nutrient media. Its optimum growth temperature is
37 ° C, pH 7.2-7.5. In liquid medium it forms a opacity and film. There are medium-sized
and large colonies (2-5 mm) of round, translucent, blue-gray, pearl shade on a plane agar.
A characteristic feature of Ps. aeruginosa is chromo- and aromagenesis due to which
nutrient media are stained in blue-green color during the growth of the microbe and have
a characteristic smell of jasmine. Pseudomonas aeruginosa ferments only glucose with an
acid formation. The proteolytic activity is high: it dilutes gelatin and coagulated serum,
curdles milk, and cause erythrocyte hemolysis. Many strains produce substances belonging
to the group of bacteriocins - piocines. 25 types of O-antigen of Ps. aeruginosa and 8 groups
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of H-antigens were described. It is resistant to antibiotics. It produces exotoxin. Microbe
is quite resistant to various external influences: it survives for 2 weeks in dust premises
and sustains ultraviolet radiation. It dies at 60° C for 15 minutes.
The basic method of laboratory diagnostic is bacteriological one during which an
important diagnostic feature is the ability to chromogenesis. In recent years the
agglutinative O-serum were obtained to serotype isolates.
Pseudomonas aeruginosa causes severe pseudomonal sepsis in burned patients. In
this regard a group of doctors conducted a study of the use of antipseudomonas vaccine for
the prevention and treatment of nosocomial infections in patients with severe burn injuries
(journal "Clinical Microbiology, Antimicrobial Chemotherapy" 2015 t.17 №4). As the
study showed “Psevdovak” vaccine reduced the mortality rate of patients, the amount of
antibiotics and other drugs used for treatment. And the number of bed - days spent by
patients in the hospital was also reduced.
The problem of complications caused by Ps. aeruginosa is still current. The use of
"Psevdovak" vaccine for the prevention and treatment of infections caused by P. aeruginosa
in burn patients is safe and can help to reduce the consumption of antimicrobials. Since the
infections caused by Pseudomonas aeruginosa are poorly treated with antibiotics, the use
of the vaccine is the best addition to the treatment.
FEATURES OF CURRENT CORONARY SYNDROME WITH CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
Usupova N., Repyeva E. - the 3rd year students
Scientific leaders – Ph.D. I.G. Menshikova, Cand.Med.Sc I.V Sklar , Katina O.I.
Coronary heart disease (CHD) refers to the most common diseases associated with
chronic obstructive pulmonary disease (COPD). COPD increases the risk of cardiovascular
disease in 2-3 times. According to some authors, the presence of COPD can be considered
as an independent risk factor for CHD along with age, smoking, hypertension, and
hypercholesterolemia. Despite the large amount of inheritance, the data on COPD and
CHD relationship remains controversial.
The aim of our research is to study the features of acute coronary syndrome (ACS)
course in patients with COPD. A retrospective analysis of 26 case histories of patients with
ACS in conjunction with COPD who were treated in the department for patients with acute
myocardial infarction GAHI AR "Blagoveshchensk City Hospital". There were 22 men (84.6%) and 4 women - (15.4%). The average age of men and women did not differ and
was about 75.4 years. The duration of COPD was 19.7 years, stable angina - 7.2 years.
Myocardial infarction (MI) with Q- wave was diagnosed in 8 (30.8%) patients, MI without
Q- wave was in 6 (23%) persons, unstable angina - in 12 (46.2%) patients. In the analysis
of the prevalence of co-morbidities it was revealed that arterial hypertension – in 20
(76.9%) patients, acute violation of cerebral circulation – in 3 (11.5%) cases,
postmyocardial infarction cardiosclerosis – in 4 (15.4%) persons, chronic heart failure – in
18 (69.2%) patients, and hypercholesterolemia – in 12 (46.2%) patients were the most
common disorders. Among studied patients there were 19 smoking men (86.4%) and 1
smoking woman (3.9%). Analysis of smoking was 63.5% pack/year. Overweight was
observed in 13 (50%) patients. The combination of pain in the heart and dyspnea were
noticed in 20 (76.9%) patients due to the presence of both pulmonary and cardiac
component. On admission to the hospital the sinus rhythm on an ECG was recorded in 15
(57.7%) patients, atrial fibrillation was in 4 (15.3%) patients, and arrythmia was in 7 (27%)
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cases. Heart rate (HR) was on average 95.6 beats per 1 minute. Anterior MI was revealed
in 6 (44.5%) patients, the lower MI – in 7 (49.2%), circular MI – in 1 (6.1%). In
echocardiography a violation of left ventricular systolic function was observed in 9
(33.9%) patients.
A combination of shortness of breath and pain, tachycardia, heart rhythm
disturbance is seen in patients with an acute coronary syndrome and COPD.
MASTITIS OF NEWBORNS
Moiseenko A., Dorozhkova E. – the 3rd year students
Scientific leaders – A.V. Sergienko, O.I. Katina
Mastitis is a purulent disease of mammary glands. The disease occurs not only in
girls but in boys. Mastitis pathogens are Streptococcus, Staphylococcus, Escherichia coli.
Purulent mastitis of newborns develops on the background of engorgement of the
mammary glands (during transport of estrogen hormones from mother to fetus). Usually
physiological swelling of the glands appears in the first 2-3 weeks of life of the newborn.
Most often mastitis of newborns develops because of a poor care (intertrigo,
omphalitis, pustular skin lesions). The infection enters the gland of the baby through the
skin or hematogenous.
In the diagnosis of infiltrative condition and phase of the disease the child should be
in a hospital and get treatment under the supervision of a physician. Thus, the conservative
therapy with the use of Vishnevsky ointment is administered. Also the compresses with
Ichthyol ointment or compresses based on an alcohol substance are applied. If mastitis of
newborns still persists and an abscess develops, the surgery is needed. The cuts are made
in the radial direction of the beam so as not to affect the channels and axillary space of the
girl. If the nipple is depressed, the incision is made away from the margin of the mamillary
fundus. It is 3-4 mm from the circumference of the areola.
The wound drain is impossible as the scars can remain, not allowing the breast skin
to stretch. As a result, the growing mammary gland may be deformed or incorrectly formed.
After the operation the child stays in the hospital for at least 2 weeks. A bandage is
put on the chest to soak the wound with a solution of sodium chloride for 3 hours. The rest
of the time a bandage with levomekol ointment is applied. Immediately after surgery the
dose of antibiotic is injected for the destruction of residual bacteria that can affect the
nearby area of the mammary gland.
PHARMACODINAMICS OF MELDONIUM
Eroputko A., Lyubitskiy G. – the 4th year students
Scientific leaders - Simonova N.V., Katina O.I.
Meldonium (mildronate) is a metabolic drug, normalizing energetic metabolism of
cells, suffered from hypoxia and ischemia. Meldonium supports the energetic metabolism
of heart and other organs.
Meldonium inhibits an enzyme gamma-butyrobetaine hydroxylase that is
responsible for synthesis of carnitine. It transports fatty acids through the membranes of
mitochondria. Due to it the concentration of carnitine in organism becomes less and process
of transporting of fatty acids through mitochondria membranes of cardiomyocytes becomes
slower. Such deceleration is very important during hypoxia, because when supply of fatty
acids is normal, but there is a lack of oxygen, the process of fatty acids oxidation is
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defective. In this case bad products, which block transporting of ATP to cells, accumulate
in cardiac muscle.
In parallel with deceleration of fatty acids metabolism, the speed of carbohydrate
metabolism grows, cytoprotective effect occurs and production of ATP becomes more
effective. Besides, meldonium activates glycolysis by itself, strengthening expression of
hexokinase, which catalysts transformation of glucose into glucose-6-phosphat.
Along with these processes, while using meldonium there is an increase of gammabutyrobetaine concentration, which dilates vessels. In case of myocardial infarction the use
of this drug slows the growth of necrotic zone, shorts the rehabilitation period, improves
blood circulation in focus of ischemia, and promotes the redistribution of blood in favor of
ischemia zone.
In case of heart failure the drug increases contractility of cardiac muscle and
resistance for physical activity, reduces the frequency of heart attacks.
Mildronate increases ability to work, reduces symptoms of physical and psychical
overstress, eliminates alcohol abuse withdrawal symptoms.
SYRINGOMYELIA
Lyubitskiy G. – the 4th year student
Scientific leaders – Cand.Med.Sc. A.I. Karnauh, O.I. Katina
Syringomyelia is a slowly progressing neurological disease characterizing by
occurrence of cavities in spinal cord or less often in medulla oblongata (syringobulbia).
There are two basic forms of the disease: communicable and non-communicable.
Of these two forms non-communicable syringomyelia is the most common. It is related to
occurrence of cysts in thickness of the spinal cord. It can be the result of injuries, tumors
or inflammations of the spinal cord. Communicable syringomyelia is a dilatation of central
canal of the spinal cord, which is often connected with such developmental anomalies
as Arnold–Chiari malformation, Dandy–Walker syndrome.
Symptoms: the beginning of the disease manifests with disorders of superficial
sensitivity, located in dermatome, which appropriated with damaged segment of the spinal
cord. If the disease develops, it causes motor and trophic disorders in muscles of
appropriated myotome because the cyst presses anterior horns of the spinal cord. Deep
sensitivity is saved.
Diagnostics is based on findings received with the help of MRI and positive
myelography.
Treatment: in prolonged and severe pain analgesics, combined with antidepressants
and antipsychotic drugs, are administered. In some cases the surgical treatment is needed.
Surgery can contribute the elimination of pain and gradual regeneration of lost sensitivity,
but full healing happens rarely.
TREATMENT OF PARKINSON’S DESEASE
Savelieva K., Danko K. – the 4th year students
Scientific leaders – R.A. Anokhina, O.I. Katina
In 1817 English physician James Parkinson published "An Essay on the shaking
palsy". He described six patients, focusing on such typical symptoms as tremor of rest,
abnormal gait and postural instability, muscle rigidity and other.
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The main theory in the pathogenesis of Parkenson’s desease is "dopamine theory".
According to it the black substance of the midbrain is responsible for a dopamine
production. It has a braking effect on the striate structures of the brain. For a number of
reasons there is damage of the black substance that leads to disinhibition of the striate
system and imbalances between the dopaminergic and glutamatergic systems in the brain.
Also the dominant influence of the cholinergic system forms. These changes lead to the
formation of the clinical picture of akineticorigid syndrome.
This treatment is symptomatic. Antiparkinsonian drugs are divided into the
following groups:
I. Substances which activate dopaminergic effects
1. The precursor of dopamine (levodopa)
2. Agents that stimulate dopamine receptors or dopaminomimetics (Bromocriptine,
ropinirole)
II. Monoamine oxidase inhibitors (selegiline)
III. Substances that suppress glutamatergic effects (midantan)
IV. Substances that suppress the cholinergic effects (trihexyphenidyl)
There are surgical methods of treatment:
1. Thalamo - and pallidotomy
2. Stimulation of the deep structures of the brain or neurostimulation
The most promising technique for the treatment of Parkinson's disease will soon
become the stem therapy. Its results have already impressed in their ambition. In 2009
during the experiment on the transplantation of nerve cells into the brain the positive results
were observed in 80% of patients. Nerve cells have replaced the dead cells. After that, the
function of the black substance was restored.
And earlier in 2003, a man with Parkinson's disease was introduced the genetic
vectors in the subthalamic nucleus. These vectors contained the gene responsible for the
synthesis of glutamatdecarboxylase. That reduced glutamatergic influence and gave a
positive therapeutic effect.
THE PATHOGENESIS OF SPONGIFORME ENCEPHALOPATHIES
Danko K., Savelieva K. – the 4th year students
Scientific leaders – Cand.Med.Sc. V.N. Karnaukh, O.I. Katina
Prions are a special class of infectious agents. They are proteins with an abnormal
tertiary structure and without nucleic acids.
The leading role in the pathogenesis of spongiforme encephalopathies is supposed
to belong to changes in body proteins of man and animals. As a result the prion proteins
PrP transform from normal and vital PrPc into changed PrPSc. Replication of prions is an
extremely complex process. The first molecule of the pathogenic form PrPSc forms due to
mutation of the gene PRNP (encoding the normal PrPc) or penetrates into the body from
an exogenous source. It initiates a chain reaction of conversion of PrPc to PrPSc. The
interaction between PrPc and PrPSc is revealed to be the basis of prions number increasing.
There is a direct interaction of prions with the DNA of the cell, directed to the region
that controls the replication of mitochondrial DNA. A decrease of replicative processes in
mitochondria was observed in a progressive amyloidosis associated with exposure to
prions. The consequence of the basic mechanism of action of prions in cells is vacuolization
and death of neurons. In case of vacuolization of the gray matter of the brain, it looks like
a sponge (spongiforme rebirth). This basic process is accompanied with proliferation of
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glial tissue (astrogliosis) and the death of the fibers of the white matter (leukospongiosis).
Known prion diseases differ in the intensity of the spongiosis, amyloidosis and gliosis in
the brain tissue.
The following diseases are noted among the most known in this group:
1. Kuru
2. Disease Creutzfeldt-Jakob
3. Syndrome Gerstmann-Straussler-Sheinker;
4. Fatal insomnia.
THEORIES OF ALZHEIMER’S DISEASE
Tiku D., Savelieva K., Danko K. – the 4th year students
Scientific leaders – Brush N.G., Katina O.I
The pathogenesis of Alzheimer's disease is shrouded in mist and there is still no
exact understanding of its structure. But there are 3 main theories existing in our time. They
are the basis of modern therapy of this pathology.
1) Chronologically, the cholinergic hypothesis was the first. According to it the
disease is caused by reduced synthesis of the neurotransmitter acetylcholine. Currently,
this hypothesis is supposed to be unlikely, as acetylcholine therapy is not very effective.
2) In 1991 the "amyloid hypothesis" was proposed. It assumes that the basic cause
of the disease is deposits of beta-amyloid (Aß). The gene encoding protein (APP), which
formed beta-amyloid, is located on chromosome 21. An interesting fact in support of the
amyloid hypothesis is the fact that almost all people suffering from Down’s syndrome
surviving to 40 years of old (an extra copy of chromosome 21 or her segment) have
Alzheimer's-like pathology. Besides APOE4, the main genetic risk factor of Alzheimer's
disease, leads to excessive accumulation of amyloid in the brain before the onset of
symptoms. At present, the amyloid hypothesis is considered to be the main one. But it is
not possible to explain all the diversity of phenomena in Alzheimer's disease. The
accumulation of beta-amyloid is considered to be not only the direct cause of the disease
but a trigger promoting the sequence of neurodegenerative changes. Many of them,
including Tau-protein pathology and death of neurons, manifest themselves only years
later.
3) There is Tau hypothesis, according to which a cascade of violations is triggered
by abnormalities in the structure of Tau protein. Presumably, the threads of the
hyperphosphorylatе Tau protein begin to unite among themselves, forming eventually
neurofibrillary tangles inside the nerve cells. It causes the disintegration of microtubules
and the collapse of the transport system inside the neuron. First it leads to the disturbance
of the biochemical signaling between cells and then to the death of cells.
PHARMACODYNAMICS OF ERYTHROPOIETIN
Gamylin K. – the 4th year student
Scientific leaders - N.V. Simonova, O.I. Katina
Erythropoietin is the physiological stimulator of erythropoiesis. It secretes in
kidneys and in perisinusoidal cells of the liver. The production of erythropoietin by liver
predominates in embryonic and prenatal period, but the renal production prevails during
adulthood. It activates the mitosis and ripening of erythrocytes from progenitor of
erythrocyte series. The secretion of erythropoietin by kidney increases during the blood
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loss, different anemic conditions (deficiency of iron, folic acid, B12 and anemia which is
connected with affection of marrow, etc.), ischemia of the kidney (for example, at the
period of traumatic shock), hypoxic conditions under the influence of glucocorticoids. It
leads to fast increasing of hemoglobin level and oxygen-supplying ability of blood during
the stress situations. Hemoglobin level and number of erythrocytes in blood increase in
several hours after an injection of exogenous erythropoietin.
Erythropoietin promotes intensive consumption of iron, copper, vitamin B12 and
folic acid by marrow. It causes the reduction of iron level, copper level and vitamin B12 in
the blood plasma, and the reduction of transport protein level: ferritin and transcobalamin.
Erythropoietin increases arterial pressure. It also enhances blood viscosity by
increasing the proportion of erythrocyte mass to blood plasma.
Oxygenous condition of the whole organism and of the kidney is determinant in the
production of erythropoietin. Cytochrom is the structural base for this function.
Stimulation of erythropoietin production is affected by activation of ferments
(phospholipase increases the activity of prostaglandins).
In fact, erythropoietin works by the connecting with erythropoietin receptor (EpoR).
Intensive manifestation of erythropoietin receptor can determine the location of
progenitor erytroid cells.
Progenitor cells have a high level of erythropoietin susceptibility. However, there
are some facts that erythropoietin receptors are located in others tissues (heart, muscle,
kidney, nerve tissue). But trustworthiness of researching results is distorted by having antiEpoR. Investigations conducted in controlled conditions have not proved the location of
receptor in these tissues. In blood erythrocytes do not react to erythropoietin receptor.
Nevertheless, there is the dependence of erythrocytes lifespan in blood on erythropoietin
level in the blood plasma.
EXPERIENCE OF TREATMENT WITH PROTON PUMP INHIBITORS
Solodova O., Zeinalov O., Bugreeva T. - the 5th year students
Scientific leaders - Cand.Med.Sc. O.M .Goncharovа, O.I. Katina
Objective: To evaluate the clinical efficacy and tolerability of Omeprazole in
patients with peptic ulcer.
The result of inoculation: The study involved 20 patients (10 patients with gastric
ulcer, 10 patients with duodenal ulcer) aged 43-67 years old; the average age was 49.2
years. All patients before their treatment appointments were conducted a standard clinical
examination in outpatient departments and policlinics. The patients (20) received
comprehensive treatment of anti-ulcer drugs (IPP- Omeprazole 20 mg 2 times a day; and
in the case of contamination of Helicobacter pilori they took two antibacterial drugs Clarithromycin 500 mg 2 times a day and Amoxicillin 1000 mg 2 times a day). The course
of treatment was on average 2 - 4 weeks. Treatment safety was assessed by monitoring the
changes in the physical condition, changes in vital signs of life, the results of laboratory
tests.
Monitoring the process of scarring carried out endoscopically. As a result of the
treatment there was a significant positive dynamics in patients of both groups. It
characterized by the disappearance of asthenovegetative and pain syndromes (88.2% 86.5% respectively). Epigastric pain disappeared in 2 or 4 days, and dyspepsia (heartburn,
regurgitation) - 3-5 days. Dryness and bitterness in the mouth, constipation and bloating
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following treatment remained at 2.8% of patients. Manifestation of asthenovegetative
syndrome was observed in 3.2% of patients after the treatment. The average healing time
of the ulcer in patients with GU and DU was 21.2 and 18.6 days, respectively. Excellent
treatment results were observed in 4% and 5.4% respectively patients, satisfactory – in
5.8% and 5.1%, poor – in 2% and 1%.
Conclusion: The findings suggest that a good therapeutic effect, convenient form,
and the multiplicity of purpose allow to recommend Omeprazole for the treatment of
exacerbations of peptic ulcer disease and the prevention of recurrence of the disease in
outpatient conditions.
FEATURE COURSE OF HEPATITIS IN CHILDREN
Dementieva N., Zeinalov O., Bugreeva T. - the 5th year students
Scientific leaders - Cand.Med.Sc. O.S.Yutkina, O.I. Katina
The prevalence of viral hepatitis is huge. Every year 2 million people die from
diseases associated with hepatitis B virus.
The etiological structure of viral hepatitis in children of the 1st year of life: the CAA
in this age group account 8.8% of cases, HBV - 57.8%, HCV - 20.6%, cytomegalovirus
hepatitis - 5.8% and in 7% the etiology cannot be deciphered. In 38% of these children the
primarily chronic hepatitis develops.
One of the most severe outcomes of acute viral hepatitis is fulminant forms,
manifested with acute liver failure. The frequency of their development is different: in viral
hepatitis A it is 0.01%, viral hepatitis B - 1%, viral hepatitis C - up to 15%, viral hepatitis
D - 30%, viral hepatitis G - 50%, viral hepatitis E to 25%.
The second major outcome of viral hepatitis is the development of chronic liver
disease with subsequent transition to cirrhosis and hepatic carcinoma.
The chance of developing the chronic liver disease with HBV-infection increases
rapidly when infected in utero, and in infancy and early childhood. When infected at the
1st year of life the chronicity rate reaches 70-90%, in 2-3 years - 40-70%, 4-6 years - 1040%, and for children older than 7 years - 6-10%.
When HCV, the chronicity of the disease occurs in 70-90% of patients with an acute
form of the disease. At present, HCV for most children is considered to be lighter and more
durable if compared with the infection acquired in adulthood. According to various sources
the development of liver cirrhosis with HCV in children in 3 - 7 years after the infection
ranges from 0% to 8%.
The main feature of HDV-superinfection is its predominant cirrhosis. It develops in
60-70% of patients with chronic hepatitis D.
Hepatitis B transmission through the placenta is in 10-50% of cases. Infection of the
newborn is possible during the passage through the birth canal, breast-feeding with blood
of cracked nipples.
Unlike HBV, the risk of transmission HCV from mother to fetus does not exceed 16%. Infection occurs both during labor and cesarean section.
The course of acute viral hepatitis A is usually favorable. In the majority of patients
the liver functions return to normal within 6 months. However, there is information
according to which the CAA may have a prolonged duration. Transplacental and parenteral
way of transmission is possible. In children more than 80% of the CAA is associated with
contact with other children. Viral hepatitis E is the viral hepatitis with the enteral
transmission. Transmission of the virus occurs mainly through contaminated water and
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food. Young people aged 15 to 30 years are infected more often. In most cases hepatitis E
has a favorable course. The possibility of process synchronization is not described. But
there may be fulminant course and almost exclusively in women in the III trimester of
pregnancy. Thus the mortality may reach 25%. Hepatitis E in most cases leads to abortion.
PECULIARITIES OF ARTERIAL HYPERTENSION AT A YOUNG AGE
Kurilova I., Kostenko K. - the 4th year students
Scientific leaders - Cand. Med. Sc. O. A. Tanсhenko, O.I. Katina
Currently, on the background of the extremely high prevalence of arterial
hypertension (AH) among the population there is a steady tendency of increasing the
proportion of persons of young age in the structure of AH. The prevalence of hypertension
among young people under 30 years of age varies from 3.4% to 40.7%.
Etiology. According to international studies the most frequent precipitating factors
of hypertension include: diabetes (35-75%), smoking (45%), frequent alcohol use (36%),
physical inactivity (34%), inflammation of the kidneys (nephritis) (34 to 60%), excessive
use of salt (11%), stress (10%). There is a high role of hereditary predisposition. The
prevalence of hypertension in adolescents and young adults with burdened anamnesis is
noted in 25-65% of cases.
Pathogenesis. Blood pressure in humans depends on a complex of various factors
making up a functional system. This system maintains the constancy of blood pressure
according to the principle of self-regulation. In hypertension the increased blood pressure
is caused by a complex interaction of genetic, psycho-social factors, maladjustment of
physiological mechanisms, and violations of the mechanisms of autoregulation of central
hemodynamics. Normally there are mechanisms of cerebral autoregulation supporting the
balance between cardiac output and peripheral vascular resistance. For example, increasing
cardiac output during physical activity the total peripheral vascular resistance is reduced.
In contrast, while increasing the total peripheral vascular resistance, a reflex decrease in
cardiac output occurs. Systemic arterial pressure begins to rise either with the depletion of
antihypertensive homeostatic mechanisms or in excessive gain of vasoconstrictor and
antinatriuretic neurohumoral systems (angiotensin II, norepinephrine, endothelin-I,
insulin). Violation of the activity of the renin-angiotensin-aldosterone system. Renin is a
protease synthesized in juxtaglomerular apparatus of the kidneys, particularly the adrenal
cortex. Renin cleaves a protein angiotenzinoguene molecule, turning it into angiotensin I.
It is not biologically active, but after the exposure with angiotensin converting enzyme
(ACE) it becomes an active octapeptide called angiotensin II. ACE is released by cells of
the lungs and blood vessels. Angiotensin II causes the constriction of blood vessels
(vasoconstriction) and also stimulates aldosterone secretion by the adrenal cortex, resulting
in increased sodium reabsorption in the kidney tubular cells with subsequent increase in
circulating plasma and increased blood pressure. Atrial natriuretic factor is a powerful
mean of inhibiting the secretion of aldosterone. Increased activity of the renin-angiotensinaldosterone system in the bloodstream and tissues plays an important role in the
pathogenesis of hypertension. In epidemiological studies it is shown that the plasma renin
level is an independent prognostic factor of arterial hypertension. In increased renin levels
a risk of complications of hypertension is 6 times higher. It is interesting to note that in
treatment of hypertension in young people inhibitors of angiotensin-converting enzyme
(ACE inhibitors) (lisinopril, captopril, enalapril), and blockers of receptors of angiotensin
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II (ARBS) (lorista, ibertan), calcium antagonists (verapamil, nifedipine), and diuretics
(hydrochlorothiazide, indapamide) are used the most frequently.
Thus to prevent the development of vascular events (acute cerebrovascular disease
and acute myocardial infarction) it is reasonable to conduct further examination of patients:
daily blood pressure monitoring, Doppler study of heart vessels and kidneys, and
measuring the metabolic processes indexes (carbohydrate and lipid), as well as timely
correction of risk factors of these diseases.
THE SPIRAL ORGAN. ORGAN OF CORTI
Nevedomskaya O., Mikhailov I. – the 2nd year students
Scientific leaders – V.S. Kozlova, O.I. Katina
The inner ear is located in the temporal bone where the organ of hearing is. The
latter one is represented by 2.5 cochlea curl and equilibrium organ. The organ of Corti is
in the membranous labyrinth. The compound part of the membranous labyrinth is
Reysner’s membrane. And vascular layer presented by multi-nuclear epithelium is located
on the spiral ligament.
Spiral organ is located on the basilar plate.
The columnar cells form a tunnel on the basal membrane. In the basal part the form
of the cells is enlarged, and in the apical one – it is narrowed. There are nerve fibers in the
tunnel extending from the hair cells. It separates the inner from the outer hair and
supporting cells.
Internal supporting phalangeal cells are in one row. There are a lot of tonofibrils in
their cytoplasm. These cells have digital growths that separate hair cells from each other.
Outer phalangeal cells are arranged in 3-4 rows. They are the same as the internal
ones but there are some differences. They have a prismatic shape. There is a cup-shaped
indentation in the outer epithelial cells where the outer hair cells are. One process is the
longest and reaches the upper surface of the helical body. Depending on the location from
the tunnel the cells have the definite names. The first cell from the tunnel is Deiters cell,
the second one is Hensen cell, and Claudius cells are the third.
The inner hair cells (sensoepitelial) are located on the outer supporting cells in one
row. They have the shape of jug. The apical surface has a reticular plate where microvilli
(stereocilia) are. The apical and basal surfaces have actin and myosin myofilaments.
Afferent nerve fibers are near the basal surface.
The outer hair cells are lined in 3-5 rows in dents of external supporting cells. They
are the same as the internal ones, but there are differences. Their shape is cylindrical,
stereocilia have V-form. Innervation is by efferent fibers. The outer hair cells are more
sensitive to sounds.
Stereocilia of hair cells contact with the covering membrane. It is a Blends Ribbon
plate of jelly-like consistency and consists of collagen and glycosaminoglycans.
Considering histophysiology of the organ of Corti, it is possible to conclude that the
process of perception of sound waves begins with the locator system. The auricle traps a
sound and it moves to the tympanic membrane. Then it passes to the hammer, anvil, and
stirrup. Through the oval window it falls into perilymph, basilar membrane and the cover
plate. The fluctuation occurs and passes to the hair cells by the stereocilia. There is the
plasmolemma depolarization. Neurotransmitter – glutamate isolates affecting the afferent
fibers of the auditory ganglion. This information is transmitted to the central part of the
acoustic analyzer by the auditory nerve.
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Pathology.
When syphilis the treatment with antibiotics is administered. As a result, thinning
and destruction of the microvilli occur. The vibrations transmitted to coating membrane
are not perceived by hair cells. Consequently, the polarization will not occur. And there
will not be any nerve impulse. So it will not be passed in the cortical center of hearing.
Syphilitics become deaf in a result of the treatment. Violation of circulation and the
chemical composition of the endolymph and perilymph result in Meniere's disease,
cochlear neuritis, age-related hearing loss, acoustic trauma, late stage of otosclerosis, etc.
ANTIBIOTICS AT PREGNANCY
Podtoptannaia A., Chenchenko V. – the 4th year students
Scientific leaders – Ph.D. N. V. Simonova, O. I.Katina
Any drugs which a woman takes during her pregnancy can negatively affect a health
of her future child. And antibiotics aren't an exception. There is a group of antibiotics that
are strictly contraindicative to future mother as they are capable to result in anomalies of a
fetus. However the statistics demonstrates that antibiotics at pregnancy are prescribed to
every second woman. As many diseases can't be cured in another way.
What antibiotics may be used at pregnancy? All drugs included in this list can be
taken during pragnancy. But it is necessary to consider that in anyway antibiotics are strong
drugs. And it is forbidden to accept them without administrations of a doctor. So, the
antibiotics resolved at pregnancy are:
- Penicillinum and its analogs (ampicillin, amoxicillin, amoxiclav) – are capable to
pass through a placenta. However, they don't have negative impact on a fetus as a rule.
During pregnancy they are quite quickly excreted from an organism by kidneys;
- Cephalosporins (Cefazolinum, Ceftriaxone, Cefalexinum, Cefixime, Cefuroxime,
Cefotaxime, Cefoperazone, Cefepime, Ceftazidime) – during incubation are used without
restrictions. They pass through a placenta in a low concentration. The negative impact on
a fetus isn't noticed;
- Macrolides (Eritromycin, Josamycin, Spiramycin) – these antibiotics as well as
cephalosporins are allowed for use at pregnancy. They pass through a placental barrier in
insignificant quantity. However, they don't cause disturbances of development and
congenital anomalies of a fetus.
MODERN VIEWS ON THE ETIOLOGY
INFLAMMATORY BOWEL DISEASES
Abuldinov A., Abuldinova O. – the 6th year students
Scientific leaders – Ph.D. V.I. Pavlenko, O.I. Katina
AND
PATHOGENESIS
OF
Inflammatory bowel diseases (IBD) are characterized by the presence of
inflammatory-destructive processes in the intestine and the recurrent course. They are:
ulcerative colitis, Crohn's disease, collagenous colitis, lymphocytic colitis and atypical
microscopic colitis.
Etiopathogenetic factors of inflammatory bowel diseases are not fully studied.
However, in accordance with modern concepts bacterial antigens (Ag) play an important
role in pathogenesis. The gastrointestinal tract is affected by a plurality of Ag: nutritional
components, bacteria, viruses and fungi. In the colon up to 60% of the total stool weight
consists of bacteria: each gram of feces contains from 1010 to 1012 bacteria (about 400–
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500 species belonging to about 30 genera). Ag and viscera are separated only by a thin
layer of cells. Mucosal immune system continuously interacts with intestinal contents
providing tolerance of nutrients and bacteria specific for the locality.
In the last decades a possible participation of various pathogens in the development
of IBD was discussed. Among them are Mycobacterium paratuberculosis, Listeria
monocytogenes, Chlamydia trachomatis, cytomegalovirus, measles virus, Saccharomyces
cerevisiae, some strains of Escherichia coli, Yersinia enterocolitica and Yersinia
pseudotuberculosis. However, these data have not been confirmed yet.
Recently it has been suggested that the symbiotic microflora also plays an important
role in the development of IBD. This is confirmed by the following facts: surgical
deactivation of loops of small bowel, leading to loss of contact with the intestinal content,
may lead to the disappearance of inflammatory changes in these segments of the intestine;
the reduction of lactobacilli or anaerobes is observed in active Crohn's disease but not in
remission.
Increased intestinal permeability is often observed in patients with IBD. It is
associated with the reduction of the so-called "locking zones". This may be due to the
association of IBD with gene loci, such as DLG5 or OCTN, occurring in some patients.
Today it is proved that at least 9 different loci are associated with IBD. The
NOD2/CARD15 gene is the most studied. This may be is just a contributing factor. But it
is quite likely that NOD2/CARD15 modulates the secretion of defensins. These are
endogenous antimicrobial proteins produced by epithelial cells of the mucosa.
In this model of IBD the start of the inflammatory cascade begins with the exposure
of Ag in the intestine. Macrophages and dendritic cells phagocytose Ag partially destroying
them. And ultimately they present Ag on the surface to the special immune cells. This leads
to the activation of proinflammatory cytokines and as a result to the destruction of the
intestinal mucosa. Patients with IBD has imbalance between pro- and antiinflammatory
cytokines. Pathological increased longevity of T-lymphocytes, supporting the pathological
process in Crohn's disease, leads to chronicity of the disease.
Thus, inflammatory bowel diseases are not associated with a weakening of the
immune system but with excessive and hyper-prolonged activation of the intestinal
immune system. Therefore, the main task of immunomodulatory therapy in IBD is the
suppression of this pathological activity and the restore of the normal balance of the
immune system.
Modern views on the IBD etiopathogenesis and the results of scientific research
explain the effectiveness of proven drug regimens (using 5-aminosalicylic acid drugs
(mesalazine), systemic corticosteroids, azathioprine) and form a theoretical basis for new
types of immunomodulatory therapy (topical corticosteroid budesonide, IL-10 monoclonal
antibody).
INGUINAL HERNIA REPAIR
Suhanova K., Pristapchuk E. – the 3rd year students
Scientific leaders – Cand.Med.Sc. A.V.Sergienko, O.I.Katina
Martynov’s suture
The lower flap of aponeurosis of the external oblique muscle is applied over the
upper one and fix with a few sutures without the tension, in order not to narrow the surface
opening of the inguinal canal. The muscles are not seized in the suture.
Kimbarovsky’s suture
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The outer flap of aponeurosis is stitched above the inner flap. After the processing
and cutting of the hernia sac the inner flap of dissected aponeurosis and the underlying
muscles are stitched from outside to inside margins departing 1 cm from the cut edge.
Girard—Spasokukotsky suture
The internal oblique and transverse muscles with the upper flap of the aponeurosis
of external oblique abdominal muscles are sutured simultaneously above the seminal cord
to the inguinal ligament. The lower flap is fixed on the upper one making duplication.
Bassini’s suture
The spermatic cord is pulled up, and the lower edges of the internal oblique and
transverse muscles with inguinal ligament are connected under it.
FOREIGN BODY OF THE STOMACH IN CHILDREN
Pristapchuk E., Suhanova K. – the 3rd year students
Scientific leaders – E.P. Ivanova, O.I. Katina
Foreign body of the stomach – is a foreign object trapped in the stomach due to
ingestion, penetrating wounds, surgery and other reasons.
Foreign bodies of the stomach present a significant risk to human health. Untimely
detection and removal of foreign bodies can cause their migration, bleeding, perforation of
the stomach with the development of peritonitis, mediastinitis, formation of infiltrates and
abscesses in the soft tissues of the thoracic and abdominal cavity. The presence of a foreign
body in the cavity of the stomach is accompanied by temporary or permanent disability,
and sometimes it is even fatal.
Causes and types of foreign bodies of the stomach:
-accidentally or intentionally swallowed objects (young children often swallow
small objects such as coins, buttons, mosaic tiles, and designer, disc batteries, seeds from
berries, toys, etc.);
-formed stones in the body (gastric bezoars, gallstones);
-subjects caught in the stomach because of trauma (as a result of wounds or open
injuries: shrapnel, bullets, pieces of glass, wood);
-objects left in surgical interventions (not absorbable ligatures, brackets, clips,
sutures, swabs).
Bezoars stones are foreign bodies of the stomach produced from fruit seeds, plant
fibers, wool, hair, resins, fats, blood clots and other indigestible substrates. Hair balls
(trichobezoar), stones of vegetable (phytobezoar) and animal (stylobate) origin, organic
bezoars (by mineralization of varnishes, resins, blood clots), foreign bodies of embryonic
origin (of dermoid cyst of the stomach), and bezoars of mixed origin (polybutane) can form
in the stomach. Gallstones can migrate into the stomach in case of the formation of a fistula
in holecystopathies penetration of gastric ulcer or gallstones.
The symptoms of foreign bodies of the stomach
Foreign bodies of the stomach of small size and rounded shape can excrete during
defecation. Objects fixed in the stomach provoke a pain in the epigastrium: constant pains
are dull and aching in nature. After a meal there may be heaviness in the stomach, nausea,
metallic taste in mouth, hypersalivation, increased pain. Multiple foreign bodies of the
stomach cause unbearable pain in the upper abdomen, dyspepsia - nausea, vomiting,
belching, loss of appetite.
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When gall stones enter into the stomach symptoms of the leading diseases are
prevalent (calculous cholecystitis or gastric ulcer). Foreign bodies of the stomach of a
traumatic origin cause massive bleeding and peritonitis.
Long-term presence of a foreign body in the stomach causes electrolyte disturbances
(gipohloremia, hypokalemia) and metabolic alkalosis.
Diagnostic of foreign bodies of the stomach
-Plain radiography of abdominal cavity
-With the help of endoscopy the final diagnosis is established; number, size and
shape of foreign bodies of the stomach are estimated.
Treatment of foreign bodies of the stomach
Treatment of foreign bodies of the stomach is determined by their shape, size and
quantity. About 80-95% of accidentally swallowed items are excreted in the process of
defecation.
Large foreign bodies of the stomach and bezoars can be endoscopically removed
through the manipulation channel of the gastroscope. For extraction of objects endoscopic
forceps or a special wire loop are used. Endoscopic removal of foreign bodies of the
stomach is contraindicated in perforation of the walls of the body.
In case of presence in the stomach such items that can't be excreted and be removed
during endoscopy, the operation of gastrotomy and removal of the foreign body is
administered. When there is the formation of holecystopathies fistula and ingestion of
gallstones into the stomach, a cholecystectomy or gastric resection is performed.
Removal of foreign bodies of the stomach caused by a penetrating wound of the
abdomen is performed as a separate stage in the process of revision laparotomy.
Prevention of ingress of foreign bodies into the stomach
To prevent accidental ingestion of the items one needs to supervise carefully for
young children, prevent the use of toys with small parts, storing small items out of reach
of children. One should abandon the habit to hold in the mouth a variety of items, be in a
hurry and talk while eating.
To exclude iatrogenic ingress of foreign bodies in the stomach it is required to use
absorbable suture material in the operation process, carrying out a thorough revision of the
wound before suturing.
MODERN CONCEPTS OF CORDOCENTESIS
Naumovа D., Gamylin K. - the 4th year students
Scientific leaders – Cand.Med.Sc. E.V. Shulzhenko, O.I. Katina
Cordocentesis (CC) - is intrauterine puncture of the umbilical cord vessels for taking
the fetus blood during pregnancy and its research. The main indications for CC are: fetal
karyotyping, diagnosis of monogenic diseases, diagnosis of congenital and hereditary
diseases, and diagnosis of hemolytic disease of the fetus arising as a result of the mother
Rh-immunization. There are several technically different variants of the fetus blood
sampling via the CC. Historically, the earliest one is a transabdominal puncture of
umbilical cord vessels in its "root" with a free hand method. Methods may include the
technique of "free hand" or the use of the puncture adapter to the ultrasonic sensor to track
the advancement of the needle on the monitor screen of ultrasound scanner. Umbilical vein
puncture is preferred due to fewer complications for a fetus if compared to fetal blood
aspiration from arteries. It is also the method of choice for the diagnosis and assessment of
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severity of hemolytic disease. Transfusion of blood to the fetus via the CC allows to treat
the severe forms of the disease.
The risk of complications when the CC is minimal, but it should not be
underestimated. Bleeding from the puncture site of the umbilical cord vessels is observed
approximately in 40% of cases. In a few cases bruising at the puncture site is described.
There is an increase of alpha-fetoprotein level in the blood of pregnant women after CC
more than in 40% of cases. It indicates the development of fetus-maternal
microhemotransfusions.
Thus, the CC is a modern method of diagnosis of various complications in the fetus
and congenital hereditary diseases.
DIC SYNDROME IN CHILDREN IN THE NEONATAL PERIOD
Mongush S., Repyeva E. - the 3rd year students
Scientific leaders - Cand.Med.Sc. N.R. Levchenko, O.I. Katina
Disseminated intravascular coagulation (DIC) syndrome is a complex general
pathological process that develops in many disease conditions. It is accompanied with a
widespread coagulation of blood in the circulatory bed and development of blockade of
microcirculation, tissue hypoxia, and impaired functioning of organs. It is a frequent and
serious complication of a variety of pathological processes in perinatal and neonatal
periods. DIC is the cause of 36-50% of all perinatal deaths. DIC in infants often occurs in
acute and lightning form.
There are four stages of DIC syndrome: 1) hypercoagulative stage, this is a stage of
increased clotting when platelets "glued"; 2) hypocoagulative stage is characterized by
decreased clotting, blood is not able to clot; 3) fibrinolytic stage, clotting is almost absent,
it is the most critical stage; 4) recovery stage, death occurs at an unfavorable course of the
disease.
Moments provoking DIC syndrome in the perinatal and neonatal periods are:
damage of the central nervous system, premature birth, fetal anoxia, septic
infection, immunological situation during pregnancy. There is a link between severe
hypoxic damage of the nervous system, prematurity and deep hemostasis disorders.
Excessive activation of blood coagulation caused by etiological factors leads to the
formation of blood clots of common tiny blood vessels. It results in the development of
microcirculatory blockade of parenchymatous organs and their ischemia, depletion of
plasma coagulation factors and platelets. Excessive activation of coagulation induces
fibrinolysis, exacerbating bleeding. Profuse bleeding and total blood incoagulability may
occur due to the depletion of coagulation factors, platelet deficiency and the development
of secondary depression of fibrinolysis. There are the predisposed factors contributing to
the DIC development in newborns. They are underdevelopment of the reticuloendothelial
system that ensures the removal of the intermediate coagulation products, inadequate
vascularisation at the microcirculatory level, and the lack of ability of compensatory
synthesis of clotting factors, vitamin K-dependent factors, AT-III, and plasminogen by the
liver.
Timely elimination of the causes of DIC, the correct treatment of the general
disease, less traumatic surgical intervention, the fight against incipient shock and
microcirculation disorders – are the most important conditions for preventing DIC and
reducing child mortality.
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IDENTIFICATION OF RISK GROUPS OF DEGENERATIVE-DYSTROPHIC
DISEASES OF THE SPINE AMONG THE IV YEAR STUDENTS OF THE AMUR
STATE MEDICAL ACADEMY
Suvorova A., Kostenko K. - the 4th year students
Scientific leaders – Ph.D. V. N. Karnaukh, O.I. Katina
The study presents data on anonymous surveys of 4th year students of the Amur
State Medical Academy. The study was made to identify the risk of degenerativedystrophic diseases of the spine, to determine the causes of their development, and to form
the action for further prevention.
The survey involved 141 students, 55 boys and 86 girls. Due to the analysis of the
questionnaires 98 people (69.5%) have pain in the back. In 82.65% of the cases (81 people)
it is a periodic pain and in 17.35% (17 people) it has a permanent character. 43 persons
(30.5%) have not focused their attention on it.
In the majority of cases there was a pain in the lumbar region of the spine (54.1 per
cent/53 persons), in cervical part it was in 25 persons (25.5%), 9 patients suffer it in the
thoracic part (9.2%) and 11 people (11.2%) marked tenderness in the cervical and lumbar
parts of the spine. By the intensity the pain was described as a discomfort (52%/51
persons), moderate (41.8%/41 persons) and painful (1%/1 person). 5 respondents (5.2 %)
felt morbidity in the form of discomfort and moderate pain. As for the character it was
aching (64.2%/63 persons), dull (19.3%/19 people), boring (10.3%/10 persons), pressing
(5.2%/5 people) and acute (1%/1 person). In 10 students it radiates to the leg or to the head.
Frequency of occurrence: 42 respondents (42.9%) feel it 1 time a week, 34 (34.6%) have
it 1-2 times per month, 14 (14.4%) - once in 2-3 months, 8 (8.1%) – 1-2 times a year. The
onset of pain is associated with a long stay in one position (62.2%/61 persons), physical
activity (21.4%/21 people), somatic diseases (6.1%/6 respondents) and diseases of the
musculoskeletal system (10.3%/10 persons).
Among 98 students noting soreness in the back there are 42 (42.9%) who go in for
sports (dancing, athletics, weightlifting, basketball, swimming and wrestling).
56 respondents (57.1%) do not relieve pain, 20 persons (20.4%) take analgetics, 14
people (14.4%) change their posture, have a rest, and sleep on a hard surface, 2 individuals
(2%) go to physical therapy and 6 persons (6.1%) have massage.
Only 13 people (13.3%) were examined by specialists, where they were diagnosed
scoliosis of the cervical and thoracic parts of the spine – 2%; osteochondrosis – 10.3%;
rotational mobility of the C1 – 1%. Other 85respondents (86.7%) were not examined.
Thus, most of the respondents (69.5%) had pain in the back, and 54.1% - in the
lumbar region. This is due to long inactivity of the majority of students (long-hour study
of students, sedentary lifestyle) on a background of weakness of the muscles and ligaments
of the spine. The causes of pain in another group of students are the grueling hours of load
in sports and their improper distribution of the load on the spine.
As most of doctors, the younger generation of professionals apply to their health
leniently (86.7% of students were not examined). Therefore, they need to think now about
their health as further progression of the pain syndrome will affect their lives.
SOMATOTROPIC HORMONE - GROWTH HORMONE
Chashina M., Zlobina A., Praskova A. – the 2nd year students
Scientific leaders – Cand.Biol.Sc. G.K. Doroshenko, O.I. Katina
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Growth hormone is produced in the anterior pituitary and affects the growth and
development of the human body. Its production depends on the activity of the
hypothalamus, which produces neurohormones - somatoliberin and somatostatin.
Somatoliberin increase the production of growth hormone by pituitary body, and
somatostatin - inhibit it. The neurohormones ensure the production of growth hormone not
only in a certain amount, but at a certain time, handling the daily fluctuations of its level
in the blood.
Growth hormone is anabolic. It facilitates the processes of synthesis in the body and
activates protein, lipid, carbohydrate and mineral exchanges.
Growth hormone performs its action with the support of other biologically active
substances.
Deficiency of GH in children is a serious violation that can cause not only stunted
growth, but and delayed sexual maturation, general physical development, and in certain
cases, dwarfism. Insufficient level of somatotropin in the adult human body affects the
overall state of metabolism.
The excess of growth hormone leads to acromegaly and gigantism. In children there
is an excessive growth in length, in adults – characteristic changes in the appearance.
Acromegaly is accompanied by disorders of lipid, carbohydrate, protein, and water
metabolism. This disease is often complicated by cardiovascular pathologies.
FASHION INFLUENCE ON HEALTH
Busarova A., Praskova A., Zlobina A. – the 2nd year students
Scientific leaders – L.G.Zherepa, O.I.Katina
Often, using these or other fashion trends in everyday life, a person does not think
about their impact on health. However, many fashion items negatively affect the general
state of the organism.
Frequent using of headphones may be the cause of permanent damage of the ear.
While repeated impact of the loud noise, there is a death of eardrum's sensory nerve endings
membrane through which a person can hear.
Chemical wave of hair spoils their structure, contributes the hair loss. After a perm
hairs become dull due to a damage of theirs external layer, they get too dry and flogged.
In the sunroom we get a large amount of concentrated UV rays to get a quick tan.
In case of abuse it can lead to serious diseases such as skin cancer.
Tight pants at the hips press the nerve endings, tighten the abdomen, and squeeze
internal organs. It leads to burning and various diseases of the pelvic organs.
Frequent wearing of high heel shoes leads to chronic strain on the muscles and
tendons, resulting in development of a posture violation, pain in the back and feet.
Miniskirt is the way to cellulite and inflammations of the female organs as because
of the cold the blood circulation is disrupted and the body increases fat layer in selfdefense.
APPROACH TO LOW ANTERIOR RESECTION SYNDROME CORRECTION
Borisov V., Zeinalov O., Bugreeva T. - the 5th year students
Scientific leaders - Cand. Med. Sc. S.V. Anikin, O.I. Katina
Anorectal region is functionally and anatomically complicated mechanism
including rectal ampulla and sphincter, parietal peritoneum and pelvic muscles with its
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receptors, anorectal angle, functional O'Beirne-Pirogov-Muthye’s sphincter, etc. This is
not surprising that the so-called low anterior resection syndrome (LARS) occurs in 18
(46.5%) cases after low rectal resection because of these all or only few organs functions
damage. The manifestations of this syndrome are variable and include anal incontinence,
constipation or frequent defecation, stool fragmentation, tenesmus, urgency. LARS causes
dysadaptation in patients and quite negatively influences to patients’ quality of life. A lot
of methods of “neorectum” creation could be used for LARS correction.
The purpose – is to improve patients’ life quality after low anterior resection of the
rectum.
Materials and methods.
The investigation is based on analysis of 40 cases of low rectal resection with
neorectum creation by ileoascendocecal transposition complex with its reversion.
We described a new method of investigation by the computer – tomography - the
so-called computer tomography peservoir defecography.
We used this method in 3,6,12 months after the surgery.
The mean age was 57 years. The mean distance between anal verge and anastomosis
was 4.5+1.1 cm. The clinical investigation was made by questionnaire conducted in 3, 6,
12 months after the surgery.
STRUCTURE OF KIDNEY AND ROLE OF FILTRATION BARRIER IN THE
DEVELOPMENT OF THE PATHOLOGY
Nevedomskaya O., Mihailov I. – the 2nd year students
Scientific leaders – V.S. Kozlova, O.I. Katina
The kidney is made up of the cortex and medulla. The nephron is structural and
functional unit of the kidney. The structure of the nephron consists of: kidney body
(Shumlyansky- Bowman’s capsule) and glomerular capillary; proximal convoluted tubule;
Henle’s loop; distal convoluted tubule; front end of the nephron.
Kidney filter consists of three layers: the first layer - is the capillary endothelium,
the second one - is the basement membrane of Bowman's capsule, and the third layer of
the inner layer of Bowman's capsule is formed by podocytes. The capillary endothelium
belongs to the fenestrated type and forms pores (fenestrae). It is covered with a layer of
glycocalyx and is formed by proteoglycans forming a negative surface charge. So the
proteins do not pass through the kidney filter due to their large size and the electrostatic
repulsion of the podocytes. The basal membrane is a mesh structure formed by very thin
collagen threads. Podocytes cover the basal membrane with intertwined legs, between
which there are wide gaps. The permeability of the kidney filter depends on the pore
formed by the basal membrane. Low molecular weight substances are easily filtered
through the renal filter. Their content in the filtrate is the same as that in plasma. With
increasing of molecular weight the solutes pass through the pores becomes difficult and
the molecular sieving occurs. Filterability of Hb molecules is about 3%, and plasma
albumin – is less than 1%. Ultrafiltrate passes through the proximal tubules, Henle’s loop,
distal tubules, collecting ducts and collective tubules. Here is the selective reabsorption of
water (97-98% of the glomerular filtrate), electrolytes and other components, resulting in
final formation of urine.
Acute renal failure (ARF) – is a reversible decrease in the glomerular filtration rate,
impaired ability to regulate water and electrolyte metabolism, acid-base status and excrete
metabolic products. There are several forms of acute renal failure. One of them is
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connected with the violation of the filtration apparatus of the kidney - prerenal form. It is
caused by a significant reduction in renal blood flow and decreased glomerular filtration
rate. Causes are associated with a decreased cardiac output; general decrease in the
circulating blood volume in the body; pulmonary embolism; surgery and trauma,
accompanied by significant blood loss; extensive burns; dehydration caused by diarrhea,
vomiting; receiving diuretics; sudden decrease in vascular tone.
Glomerular proteinuria is due to an increase in the filtration of plasma proteins
through the glomerular capillaries. It depends on the structural and functional condition of
the walls of the glomerular capillaries; properties of the protein molecules; pressure and
flow rate, determining the glomerular filtration rate. In the pathology the size of "pores"
increases. And deposition of immune complexes cause local changes in the capillary walls
and increase its permeability to macromolecules. Electrostatic factors are also important.
In normal conditions, the negative charge of the glomerular filter repels anions - negatively
charged molecules (including molecules of albumin). Change of the charge contributes the
albumin filtration. Tubular proteinuria is due to the inability of the proximal tubules to
reabsorb plasma low molecular weight proteins filtered in normal glomeruli.
EFFECTS OF FIRE IN THE AMUR REGION FOR 2015-2016 YEAR
Gorobets M. – the 2nd year student
Scientific leaders - O.I. Katina
According to official statistics, there were 701 fires in the first half of 2016 in the
Amur region. It is 67 fires less than in the same period of 2015. This year 3657 small fires
were registered. In 2015 it numbered 3807. For the first six months of 2016 there were 38
deaths due to the fire, and in 2015 - 41. The number of victims in 2016 is 29 persons. While
in 2015 it amounted 46 people.
The number of people, dead in fires in 2016, increased in 3% if compared with the
last year. In this regard, it was decided to strengthen the work with the population on fire
safety and provide the conditions for the taking of water from all available sources.
According to the results of 10 months in 2016 the increase in the number of deaths
in fires was registered in 12 municipalities of the region. 70% of fires occur in residential
buildings. And the main causes of death of people during fires are: careless handling of fire
- 62%; violation of rules of operation with furnace heating - 7%; violation of the operation
rules with electrical equipment and household appliances - 24%.
TRANSCRANIAL DIRECT CURRENT STIMULATION
Shashlova E. – the 2nd year student, Yatcenko E. – the 5th year student
Scientific leaders - O.I. Katina
Trans Cranial Direct Current Stimulation (tDCS) – is a form of neurostimulation, in
which a certain area is affected by a low current (0.5 - 2 mA). This method is designed to
help patients with brain injuries, for example after a stroke. However, there is a positive
effect in healthy people too. For example, they experience the improvement of the
linguistic and mathematical abilities, stability of attention, problem solving, memory, and
coordination. tDCS also successfully helps in the treatment of depression.
tDCS acts directly on the nervous tissue – a system of interconnected nerve cells
and glia that provide specific functions of the perception of stimuli, excitement, nerve
impulse generation and transmission of it. One of the components of the nervous system is
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the neuroglia or simply glia - a set of supporting cells of the nervous tissue. This is a microenvironment for neuronal components performing support, trophic, secretory, separating
and protection functions. The second component is the neurons. These are electrically
excitable cells that process, keep and transmit information by electrical and chemical
signaling.
During tDCS experiments it was found that these cells respond to direct current
changing the form and molecular expression of some proteins. Axons length increases and
the orientation is shifted toward the cathode. Microglial cells increase the expression
of cyclooxygenase-2. Astrocytes take an elongated shape and orient perpendicularly to the
DC electric field.
THE 60 ANNIVERSARY OF NEUROLOGIC SERVICE IN THE AMUR REGION
Votyakov A. – the 4th year student
Scientific leaders – Ph.D. V.I. Karnaukh, O. I. Katina
The establishment of neurologic service in the Amur region is considered to be
1956. This year the first building of the regional hospital was erected and the organization
of the regional hospital began its work. 35 neurologic beds were given under the leadership
of Ya.V. Voytsekhovskaya and L.A. Solomina. In 5 years the self-contained neurological
unit was organized on this base. In the same years the outpatient appointments in policlinics
of Blagoveshchensk and in other districts of the region were opened.
1956 is also considered to be one of turning points in the history of neurologic
service of the Amur region because the chair of nervous diseases with a course of
neurosurgery was organized. It became the main base of training of neurologists in the
Amur region. Professor Grigory Yakovlevich Liberzon was its institutor and the first head.
In the same year the scientific society of neurologists and psychiatrists was made under the
leadership of G. Ya. Liberzon. It was the branch of the All-Russian society of neurologists
and psychiatrists where annual regional clinical conferences, monthly intramural and
extramural seminars on topical issues of neurology were organized. And the students’
scientific circle began to work.
Then, after G.Ya. Liberzon departure, professor, Ph.D Zinaida Andreevna
Ushakova was the head of the chair from 1962 to 2000. She also administered the work of
society of neurologists. Medical activity of neurologic patients was conducted earlier. In
the forties years of 20th century the outpatient appointment of patients with diseases of
nervous system was made for the first time.
In different years highly qualified specialists trained medical arts for future
neurologists - Usmanova A. F., Lobova A. A., Markevich L. I., Sirik L. M., Kudrin A. G.,
Eremenko V. I., Homenko E. I., Barabash I. A. were the teachers of the department.
Since 2000 and till present time the honored doctor of the Russian Federation,
professor Alexander Ivanovich Karnaukh is the head of the department.
Now the staff of the department is actively engaged in organizational and
methodical work tutoring not only students, but doctors. Scientific work on clinicepidemiological studying of a number of neurologic diseases is constantly conducted.
VACCINAL PREVENTION IN QUESTIONS AND ANSWERS
Poplavskya A., Yatsenko E. - the 5th year students
Scientific leaders - O.S. Utkina, O.I. Katina
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Vaccinal prevention – is the only method of fight with the most dangerous infectious
diseases. At present there are obviously no more effective preventive medicine programs
than vaccination. Unfortunately, at the present time the number of unjustified denials of
vaccinations has increased. This is related to antivacinal mood of parents. This report is
constructed in the form of questions and answers that will help to deal with the problem.
Why vaccinate a child, if you can just limit the contact with sick people and
strengthen the immune system?
A child cannot be isolated from the society - it is a well-known fact. Moreover, the
parents go to work every day, where an infection is “waiting” for them. Thus, we can infect
the child! Unvaccinated child suffers any disease much heavier. And hardening and
strengthening the immune system is simply useless against such diseases as tetanus,
measles and diphtheria.
Why vaccinate a child against diseases that almost never occur in our country,
such as polio, diphtheria, whooping cough?
Some children infections are really diagnosed quite rare, but only thanks to
vaccination. Without the vaccine (and therefore without the immune) the child is unarmed
before the disease and risks to be infected after the first contact with a carrier.
Is it true that vaccines contain preservatives, such as thiomersal, dangerous to
children's health?
Thiomersal - is an organic mercury compound that is no longer used in the
production of vaccines included in the routine childhood immunization schedule. A small
amount of mercury was used in the production of vaccines to their best safety. Thus,
thimerosal was not accumulated in the body and was fully excreted from it within 3 days
by the gastrointestinal tract.
May simultaneous inoculations provoke an increased load on the child's
immune system?
Despite the fact that after the birth the immune system continues to form for some
time, it is able to take vaccines appropriate to the schedule. Vaccines not only affect but
help the immune system to expand its capabilities.
MODERN METHODS OF GONORRHEA DIAGNOSIS
Chudnov D., Klyachin K., Pernitsky S. – the 3rd year students
Scientific leaders – Cand.Med.Sc. A.V. Prokopenko, O.I. Katina
Gonorrhea is a serious sexually transmitted disease that can eventually lead to
chronic inflammatory conditions of the genitourinary system and infertility. The agent of
the disease is the gonococcus.
The disease itself can be overt quite a long time. Therefore, patients may not even
suspect the existence of gonorrhea. It is a disease of an infectious nature, which is sexually
transmitted. Often the symptoms appear very quickly in one sexual partner. That is why
the early detection of the disease in the early stages of development is important.
Diagnosis of gonorrhea is to analyze the patient's complaints, his examination and
laboratory studies of the material. Laboratory diagnosis of gonorrhea allows to detect
effectively the presence of gonorrhea in the material. History of life of the patient plays a
significant role in the diagnosis. They are his lifestyle, sex, the presence or absence of a
permanent partner.
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Prevention of the disease is in timely and qualified diagnostics, and complex
treatment of gonorrhea. It is forbidden to treat the disease by yourself, to apply the methods
of traditional medicine, to treat the disease at home without a medical supervision.
PANCREAS
Klyachin K., Chudnov D., Pernitsky S. – the 3rd year students
Scientific leaders – Cand.Med.Sc. A.V. Sergienko, O.I. Katina
The pancreas is located retroperitoneal, behind the stomach in the upper abdomen.
Functionally and anatomically it is connected with the duodenum, liver and stomach.
Pancreas is projected on the anterior abdominal wall in the horizontal line connecting the
ends of the VII-VIII ribs, or in horizontal line passing through the middle of the distance
between the xiphoid process and the umbilicus, which corresponds to the level of the body
of the I lumbar vertebra.
The pancreas form is elongated, arcuate, hammer shaped and angulate.
Conventionally it is divided into three sections: the head, body, and tail.
There is also the area between the head and the body - neck of the pancreas.
Pathogenesis. Despite a large number of causes of acute pancreatitis, the disease
develops the same way. The self-digestion of the gland takes place under the influence of
aggressive enzymes: trypsin and peptidase break down proteins, lipase and phospholipase
- fats, amylase - carbohydrates. Edematous pancreatitis develops first. It runs without
consequences due to timely treatment. In severe cases the swelling progresses, compresses
the blood vessels that feed the body resulting in the formation of foci of necrosis and the
development of necrotizing pancreatitis. This form of the disease in the small focal necrosis
is relatively mild. With large focal necrosis it has a severe character. And in total necrosis
pancreatitis proceeds at lightning speed, all tissue of the gland sphacelate and the patient
usually dies. Mild forms of the disease occur more often, so the mortality in acute
pancreatitis is low.
LASER TREATMENT OF WOUND
Pernitsky S., Chudnov D., Klyachin K. – the 3rd year students
Scientific leaders – E.P. Ivanova, O.I. Katina
In recent years the method of influence on the wound with the light energy of the
optical quantum generator (laser) - the laser is quite intensively studied in the experiment
and is already used in the clinic. Several types of laser systems of different capacities
(helium-neon laser (LH-36, LH-75), a laser-based CO2) are used in the clinic.
For the prevention of wound infection and purulent wound treatment the laser is
used in two ways. The first one – is a laser scalpel. This is a focused beam of high-power
CO2 laser. Surgical treatment of a wound or the purulent focus is bloodless, leads to a rapid
and complete removal of damaged tissues and almost completely relieves the wound from
microorganisms. The antimicrobial effect of CO2 laser beam is caused by the direct
microbocydal action of the beam. Clinical and bacteriological effects of laser scalpel use
are favorable. However, according to the available observations the prolonged impairment
of circulation in the viable tissue of walls and bottom of the wound caused by the laser at
the drift of microorganisms can lead to festering of wounds.
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UMBILICAL HERNIA IN NEWBORNS
Loiko A., Golubnichaya A. – the 3rd year students
Scientific leaders – A.V.Sergienko, O.I. Katina
The navel of the newborn is formed at the location of the umbilical ring. In the
period of intrauterine development of the fetus the elements of the umbilical cord
(umbilical artery, umbilical vein and urinary duct) has passed through the umbilical ring.
After the baby’s birth and the umbilical ligation (and its further intersection), the umbilical
ring in most cases becomes obliterating with the formation of a solid scar. In some cases
the scar formation is either slow or it is not formed efficiently. In these children a protrusion
called an umbilical hernia is formed in the region of the umbilical ring with an increase of
intra-abdominal pressure. This protrusion may occur during the early period after the birth
or after a short time after the birth. Its size can vary from a small pea to a tremendous plum.
Reasons for a long uncovering of the umbilical ring can be the following:
- the child was born premature or with low weight;
- hernia can occur within the first year of life, violations will be frequent
constipation, bloating or a long hysterical cry;
- sometimes the umbilical hernia in newborns is formed without any apparent
reasons, but in this case it is again a consequence of violation of the rules and norms of
behavior of a pregnant woman.
Recommendations to parents:
1. At the slightest delay of a stool looks for ways to norm the work of intestines.
2. You should also closely monitor the child's diet.
3. Lay the baby on his tummy as often as possible and do massage.
4. To do physical therapy with the child.
HISTOPHYSIOLOGY OF SPINAL CORD AT NORM AND TRAUMATIC
DISEASE
Iazykova A. – the 2nd year student
Scientific leaders – V.S. Kozlova, O.I. Katina
The spinal cord - is a part of our central nervous system. It coordinates the work of
muscles and organs, carries to the brain the information from all parts of the body. The
spinal cord is made up of two symmetrical parts separated forward by an anterior
intermediate slot, in the back – by the posterior intermediate groove. It is characterize by a
segmental structure. In the spinal cord there is a gray substance located in its central part
and a white substance that lies along the periphery.
Gray matter in cross section has the form of a butterfly and includes twin anterior,
lateral and posterior horns. Gray matter horns of both symmetrical parts of the spinal cord
are connected to each other in the area of anterior and posterior gray commissure. The gray
substance of the spinal cord consists of neurons bodies, unmyelinic and thin myelinic
fibers.
The cells similar in structure, size and functional significance lie in the gray matter
in groups, which are called nuclei. There is a spongy layer, gelatinous substance, the proper
substance of the posterior horn and thorasic nucleus in the posterior horns. In lateral sides
there are medial intermediate core and lateral intermediate nucleus. In the anterior horns
they distinguish dorsomedial, ventrolateral, central, dorsolateral and ventromedial nuclei.
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White matter of the spinal cord is a collection of longitudinally oriented mainly
myelinic fibers forming the ascending and descending paths. White substance is divided
by anterior and posterior roots into the symmetrical dorsal, ventral and lateral cords. The
connection between all departments of the central nervous system occurs along the
conducting paths formed by white matter that is located around the gray one.
External border glial membrane consisting of fused flattened processes of astrocytes
forms the outer boundary of the white matter of the spinal cord. It separates the central
nervous system from the peripheral nervous system. This membrane is pierced by nerve
fibers comprising the anterior and posterior roots.
The spinal cord is divided into segments. Each of 31segments branches into the pair
of anterior and posterior roots. The anterior roots are responsible for motor function and
the posterior ones - for sensitive function. Each segment of the spinal cord is established
to innervate three transverse sections (metameres) – its own, upper one and lower one. This
is a unique safety factor. In case of damage of one or two metameres all functions remain.
The control for the work of individual organs or muscles and transmission of counter
information will stop if three neighboring segments are damaged simultaneously.
Damage of the spinal cord is the defeat because of injury, illness of any part of the
spinal cord or nerves of the spinal canal. These injuries often cause impairment or loss of
motor or sensory functions. Severe injury of the spinal cord causes severe traumatic lesion
of the spinal cord with the formation of cysts, coarse fiber glial scar, collapse of the myelin
coats of damaged fibers of spinal canal and prolonged (up to 130 days) inflammatory
reaction.
Enhanced development of modern biomedical technologies, the development of
methods of cultivation of somatic and stem cells as well as the modified cell lines opened
the prospect to use the possibilities of cell and tissue substitution therapy and the effects of
spinal cord injury. Transdifferentiation of mesenchymal bone marrow stem cells in the
neuronal direction and their early transplantation into the damaged area may be the best
way of surgical rehabilitation of patients with severe spinal cord injury.
Neural transplantation – is a promising method for the treatment of traumatic spinal
cord injuries. It is based on the possibility of replacing the lost cellular elements and
stimulation of compensatory and regenerative processes. Embryonic neural stem cells are
kept and divided in tissue culture in vitro and then are used for transplantation to restore
the functions of damaged brain and spinal cord.
THE CAUSATIVE AGENTS OF CATHETER-RELATED INFECTIONS
Goncharova А., Alkhimova N. – the 3rd year students
Scientific leaders - A. V. Prokopenko, O.I. Katina
There is great number of operations performed every day. Most of the operations
require the necessity to keep in body cavities drainages and catheters for a long time. But
they being in contact with the external environment become infected. All catheters can be
colonized by bacteria as a result of destruction of the skin in the injection area,
contamination during insertion or maintenance of catheters and bacteremia in patients with
distant foci of infection.
Patients receiving parenteral nutrition are more sensitive as a high concentration of
glucose promotes the growth of microorganisms.
Most often in catheter – associated infections are:
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1. Coagulase-negative staphylococci (S. epidermidis, S. Saprophyticus) – 3449.1%;
2. Staphylococcus aureus is 11.9-17%. Staphylococcal infections are acute bacterial
anthroponosis diseases with different mechanisms of transmission, characterized by a
polymorphic clinical picture. Among them coagulase-negative staphylococci (S.
epidermidis, S. Saprophyticus) and coagulasepositive (S.aureus) cause catheter –
associated infections. Staphylococci – are fixed gram-positive cocci, the cell diameter is
from 0.6 to 1.2 microns. S.aureus spreads by air-droplets and by contact-household. It is
pathogenic for the organism. Due to coagulase activity there is an early blockade of
lymphatic vessels that leads to limiting the spread of infection and clinically is manifested
by the appearance of the infiltrative necrotic and suppurative inflammation. Epidermal
Staphylococcus is an opportunistic. It inhabits all mucous membranes or any area of the
skin. The vast majority of infections occur in weakened people. Through vascular and
urethral catheters it pierces the body and can cause blood poisoning and endocarditis. S.
aureus is an opportunistic microorganism. It often causes inflammation of the bladder
(sometimes kidney) in women.
3. Enterococcus spp.( Enterococcus faecalis) – 5.9-6%. The genus Enterococcus
belongs to the facultative anaerobic asporogenous chemoorganotrophic gram-positive
bacteria. These bacteria are consorbents of human intestines. They survive in the soil and
food products and multiply at room temperature. The spece E. Faecalis is of primary
importance in human pathology as it causes sepsis, inflamation of the urinary and digestive
pathways and organs, skin and subcutaneous tissue in a weakened organism. Strain E.
faecalis is antagonist for other pathogens.
4. Candida spp. (Candida Albicans, Candida Parapsilosis) – 7.2-9%. Fungi of the
genus Candida consist of oval budding yeast cells (4-8 µm), pseudohyphas and septate
hyphas. C. albicans forms chlamydospores. Incorrect prescription of antibiotics, immune
deficiencies, increased skin moisture, damage of the skin and mucous membranes facilitate
the development of candidosis. Candidiasis is often caused by C. albicans producing
proteases and integrirovanie molecules for adhesion to extracellular matrix proteins and
other virulence factors. Candida cause visceral candidiasis (candidiasis of the urinary
system), candidiasis of skin and nails, allergies to the antigens Candida.
5. Pseudomonas spp. (P. Aeruginosa) is 4.9-6%. These are gram-negative motile
aerobic microorganisms (0.5-0.6 x 1.5 microns) in the form of sticks with a flagellum
without a distinct capsule. P. aeruginosa grows better in a humid environment and can
accumulate in the hospital dust. The pathogenic effect of P. aeruginosa is implemented
using the complex of exoproducts: pigments, enzymes, toxins. Boric and formic acids,
potassium permanganate affect it destructively.
6. Enterobacteriaceae (Escherichia coli) is 1-2%. E. coli are gram-negative rods (26 microns), paraneoplasia, facultative anaerobic bacteria. Source of infection is sick people
or a carrier. It is pathogenic and highly virulent.
Diagnosis. In order to obtain material for microbiological examination of catheters
without removing them a special nylon brushes attached to the conductor were developed.
They allow to collect the bioenvelop from the inner surface of the catheter. As a shortcut
method it is also proposed to conduct the microscopy of blood samples stained by the gram
stain or acridine orange, obtained from the suspected catheter. The study of the precipitate
obtained during centrifugation of native blood is also possible.
Catheter colonization was defined as growth of less than 105 CFU/ml. Infection of
the catheter is determined with the growth of more than 105 CFU/ml without signs of
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systemic infection and in case of negative results of blood culture. Cattery sepsis is defined
when the growth of 105 or more CFU/ml in a patient with positive results of blood culture,
signs of sepsis or both of these indicators. And this tube should be either removed or
replaced with a new one.
Treatment. When proven catheter infection, the treatment should continue from 7
to 15 days. In patients with impaired immunity or patients with sepsis it may take a longer
period. If within 48-72 hours the patient does not respond to the treatment, the catheter
should be removed and sent for inoculation. And scheme of antibiotic therapy should be
corrected.
Prevention. Hand washing or their treatment using products based on alcohol (the
2% solution of chlorhexidine gluconate) as before the catheter’s appliance so as during
manipulations with it are the most important measures that can significantly reduce the
spread of infection. Maximal amount of aseptic technique during catheterization is proved
to reduce the incidence of catheter-related infections significantly.
Conclusion. Recognition of the relevance of the problem, development of
organizational - methodological guidance and standards for cannulation and care of the
catheters, training of medical personnel on these issues will reduce the number of emerging
catheter-related infections.
COUVELAIRE UTERUS
Geras’kina E., Enzak A. – the 5th year students
Scientific leaders – Doc.Med.Sc. D.S. Lysyak, O.I. Katina
Couvelaire uterus occurs in premature detachment of the placenta. In placenta
abruption zone the blood seeps into the myometrium and perimetric fat. Bloodlogged
uterus loses its ability to contract and is accompanied by DIC. Fetus dies due to acute
hypoxia. And also the mother may die because of an acute bleeding.
The decision about the tactics of conducting a patient is made taking into account
her clinical condition. Couvelaire uterus is not an absolute indication for hysterectomy.
Modern medicine has effective pharmacological hemostatic drugs and there are surgical
ablative methods to stop bleeding. It is recommended to start with the local and systemic
appliance of uterotonics. If the uterus does not contract and hemostasis is not achieved, the
ligation of internal iliac arteries, suturing, or embolization of uterine vessels are performed.
Only in the absence of effective organ-saved methods the hysterectomy is made.
The first ligation of tubal arteries was performed by Waters in 1952. Uterine artery
embolization is proposed by Dr. Jacques Ravina in 1995. The embolization drug is injected
through a catheter under the control of angiography. Its particles occlude the vessels.
Stitching of compression sutures on the uterus was first described by B-Lynch and his
colleagues in 1997. This method was used for cesarean section and uterine atony not
amenable to pruning treatment. The key role is for the implementation of the uterine
compression when tightening knots. These methods allow to stop uterine bleeding to
preserve a woman's fertility function.
To save the life of the woman in childbirth in addition to stopping the bleeding an
adequate replenishment of blood loss, anti-hemorrhagic shock and DIC are very important.
System for continuous autotransfusion of blood cellsever offers an alternative to the
conventional surgery using donor blood. Autotransfusion of blood is used in abundant
blood loss during surgery.
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Autoplazmodonating. The essence of the method is in the collection, freezing and
storage of woman’s plasma for later transfusion of it during or after the delivery in order
to recover the volume of circulating plasma and clotting factors, as well as to relief or treat
the DIC.
Thus, modern technologies to stop bleeding or blood-implementation allow to save
not only the life of the patient, but also hers fertile function.
HISTOPHYSIOLOGY STOMACH IN NORMAL AND IN GASTRIC ULCER
Zlobina A. – the 2nd year student
Scientific leaders – V.S. Kozlova, O.I. Katina
At present the problem of gastric diseases becomes important. Diseases of the
stomach play a significant role among all illnesses of the gastrointestinal tract.
In the body the stomach has a number of important functions: secretion, which
consists in the producing of gastric juice by glands. There are enzymes pepsin, rennin,
lipase, gastriksin and hydrochloric acid, mucus, water, bicarbonates, chlorides, sulfates,
phosphates in its composition. Also, the stomach performs mechanical, endocrine, suction,
antianemic factor, and other functions.
The
wall
of
the
stomach consists
of mucosa, submucosa, muscular
coat and serosa. The mucosa is represented by a single layer of prismatic glandular
epithelium, lamina propria where gastric glands with laminae loose of connective tissue
between them are located, and muscular plate formed by smooth muscle tissue. Submucosa
consists of loose connective tissue containing elastic fibers. The muscular layer is formed
by smooth muscle cells. Serous membrane of the stomach forms its external part.
The glands of the stomach have the isthmus, cervix and the main part represented
by the body and the bottom. There are own stomach glands. They are simple, not
branched tubular glands. These glands contain a major exocrine cells, parietal exocrine
cells, mucocytes and not specialized epithelial cells. Pyloric glands are located rarer. They
are highly branched, have wide gaps and lack of parietal cells. Cardial glands are highly
branched. They include gastrointestinal endocrinocytes. They are divided into several types
and produce biologically active substances.
Physiological regeneration occurs in the bottom of the stomach by the proliferation
of cervical cells. And in the pyloric part of the stomach - due to the proliferation of pit
cells. Reparative regeneration in acute lesions of the gastric mucosa is carried out by
restitution type with the full restoration of the structure and function due to the proliferation
of not specialized cells. At pathological regeneration gastric metaplasia may occur. This is
a disease associated with structural changes of the epithelium. As a result it becomes
similar to the mucosal tissues of small or large intestine.
At present the most common pathology with the mucosal lesion of gastric walls is
gastritis of various etiologies. The most dangerous pathology is the peptic ulcer. It is a
chronic disease in which there is the formation of ulcers of the gastric mucosa. The main
etiological factor in the formation of gastric ulcer is infection with Helicobacter pylori. The
primary substrate of ulcers occurrence is the erosion. This is a superficial damage of gastric
epithelium emerging on the backdrop of mucosal necrosis. Acute ulcer is formed in the
propagation of the pathological process deeper into mucosa. Progression and
strengthening of inflammatory processes in ulcerative area lead to increased formation
of cicatrical tissue. Due to this process the bottom and edges of chronic ulcers become
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dense and differ in color from the surrounding healthy tissues. Chronic ulcer tends to
increase and deepen during the exacerbation. When remission it is reduced in size.
HYPOVOLEMIC SHOCK
Goncharova А., Alkhimova N. – the 3rd year students
Scientific leaders - M. E. Ostyakova, O.I. Katina
The problem of the shock remains to be relevant at all times as military conflicts
and acts of terrorism, natural and manmade disasters do not stop, the number of patients
with infectious diseases does not decrease, and destructive diseases of internal organs
become " younger".
Shock is an acute syndrome characterized by a sudden decrease of capillary blood
flow in various organs, an insufficient supply of oxygen, inadequate removal of metabolic
products from tissues. It manifests in severe disturbances of functions of the body.
Hypovolemia is the basis of hypovolemic shock. It is a decrease of circulating fluid
volume.
According to the etiology there are:
1. Hemorrhagic shock - in bleeding with minimal tissue injury (an intensive
bleeding in the short term - pulmonary, gastric, when damaged arteries).
2. Dehydration – losses of fluid with stool, vomit, urine, insufficient fluid intake,
massive burns due to the plasma loss.
The pathogenesis of shock is identical for all types of shock, as it is a nonspecific,
general pathological reaction of an organism in response to acute blood circulation
disorders and metabolic disorders. The main pathogenetic link is hypovolemia either
absolute (blood loss) or relative (decrease of minute blood volume and venous return to the
heart).
General pathophysiological aspects of shock:
- Pathophysiological shock means a disturbance of microcirculation, the decrease in
perfusion of organs and tissues, oxygen and energy substrates delivery. It leads to the
transition of aerobic metabolism to anaerobic.
- Acidosis increases in the cells. Due to insufficient formation of energy there is the
disturbance in the work of potassium/sodium pump and ions of hydrogen and sodium enter
the cell holding several water molecules. And potassium ions leave the cell and are excreted
from the body with the urine.
- A number of mediators contribute to the increased permeability of the endothelium
with the movement of plasma proteins and water into the interstitial space.
- Reperfusion is a mandatory result of the treatment of all circulatory disorders. The
more expressed and longer was the period of hypoxia, the harder reperfusion is. Therefore,
the earlier and more effective treatment of impaired circulation, the less the secondary
damage caused by reperfusion.
- Direct hypoxic damages and reperfusion are the cause of the organ dysfunction. If
dysfunction affects two or more organs, they suspect the development of multiple organ
failure.
The most important compensatory response in hypovolemia is the centralization of
blood circulation. Developed hypovolemia sequentially activates two types of
compensatory – adaptive reactions:
Vasoconstrictor type: activation of sympathoadrenal and pituitary-adrenal systems.
Hypovolemia leads to a decrease in blood pressure, baroreceptors are irritated. This
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mechanism is triggered by the CNS. The release of catecholamines and corticosteroids
occurs.
Vasodilatatory type: mechanisms are directed on elimination of ischemia.
Vasoactive amines, polypeptides, etc. are formed. Decompensation develops and the shock
becomes more severe.
Conclusions:
- in critical conditions violations are typically of a mixed nature. It requires a
dynamic laboratory monitoring of the electrolyte composition of erythrocytes, plasma
and urine;
- selection of the volume and composition of infusion measures is carried out
individually basing on the kind of dyshydria;
- the BCC deficit is the cause of reduced venous return blood to the right heart
and, consequently, to the left one;
- a decrease in cardiac output is accompanied by a decrease in blood pressure
in the systemic circulation and in the microvasculature. In this regard the delivery of
oxygen to cells decreases and aerobic metabolism impairs.
HISTOPHYSIOLOGY OF THE LIVER AT NORM AND ITS MORPHOLOGICAL
CHANGES WHEN HEPATITIS OF VARIOUS ETIOLOGY
Praskova A. – the 2nd year student
Scientific leaders – V.S. Kozlova, O.I. Katina
Nowadays liver diseases are an urgent problem for medicine as they take a leading
place among all diseases of the gastrointestinal tract.
The liver – is a vitally important exocrine gland performing over 500 metabolic
functions.
The structural and functional unit of the liver –is a hepatic lobe. It has a shape of
hexagonal pyramid. There is a central vein in the center of it. Lobe is represented by strands
of hepatocytes. Hepatocyte has an irregular polygonal shape, 20% of the cells contain two
nuclei. The cell has two sides: biliary (forms the wall of bile capillary) and vascular (facing
the sine wave). Hepatocyte cytoplasm differs in a high content of ribonucleoproteins,
inclusions of glycogen, lipids, lipofuscin. It contains all comportments.
The wall of the sinusoid is represented by fenestrated endothelial cells connecting
the capillary lumen with the space of Disse. There are Kupffer cells - macrophages between
the endothelial cells. They take part in the protective reaction of the liver. Patching cells
are adjacent to the endothelium. They have killer activity and the ability to stimulate the
proliferation of liver cells. There are Ito cells in the space of Disse. They are capable to
deposite fat-soluble vitamins. Mixed blood flows in the sinusoids. They get it from the
portal vein and the hepatic artery, branching in the liver parenchyma on small vessels and
merging together. The outflow of blood goes through a central vein into the inferior vena
cava.
The liver has a high ability to physiological and reparative regeneration.
Regeneration process occurs through hypertrophy and proliferation of hepatocytes.
Affect of toxins or viruses on the liver causes alteration – the hepatocyte necrosis,
degeneration development and release of inflammatory mediators. It results in poor
circulation, formation of exudate and inflammatory cell infiltration. Integration of
hepatocytes is violated. There the amount of glycogen reduces and phagocytic activity of
hepatic macrophages is suppressed. Then, the cell proliferation occurs resulting in growth
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of connective tissue in the area of hepatocytes spot loss. All of these changes are in the
cause of hepatitis. Most often the exposure to hepatotropic viruses (viral hepatitis) and
alcohol (alcoholic hepatitis) results in it. Viral hepatitis is of three types: A, B and C. Viral
hepatitis B is characterized by cellular infiltration of the stroma penetrating into the lobule
and leading to the development of balloon degeneration and necrosis of hepatocytes.
Regenerative processes are violated and there is a reorganization of the liver tissue. At
alcoholic hepatitis there is a large number of alcoholic hyaline in the cytoplasm of
hepatocytes. It leads to cell death. Changes often occur on the background of fatty
degeneration and infiltration of the stroma. Cirrhosis may be the outcome of the
progression of these changes. It is the fibrous degeneration of the liver parenchyma.
HISTOPHYSIOLOGY OF ADRENAL MEDULLA AT NORM AND PATHOLOGY
Saryglar Ch. – the 2nd year student
Scientific leaders - V.S. Kozlova, O.I.Katina
The adrenal glands – are paired organs of endocrine glands. The adrenal glands are
covered by a capsule of dense fibrous connective tissue. The cortex located on the
periphery is clearly seen in the gland parenchyma. The cortex consists of bands of epithelial
cells. The connective tissue layers carrying blood vessels and nerve fibers determine the
shape and arrangement of them. And between there are the bands of epithelial glandular
cells arranged perpendicular to the capsule.
There are 3 zones in the cortex: glomerular, beam, and net.
There is a glomerular zone under the capsule. Here mineralocorticoids (aldosterone
that stimulates an inflammatory response, wound healing due to the repair of connective
tissue) are produced. Hormones regulate water-salt metabolism. Aldosterone promotes
sodium reabsorption in kidney.
Beam zone is the widest area. In this zone glucocorticoid hormones (cortisol,
cortisone, hydrocortisone, corticosteroids) are produced. They increase metabolism,
energy metabolism, and stabilize the membranes. They inhibit the inflammatory process,
reduce immunity, destroy lymphocytes and eosinophils, cause the atrophy of the
glomerular layer and the loss of adrenal cortex.
Sex hormones (androgens being the substances - precursors of estrogens) are
produced in net zone. These hormones play a different role than the hormones secreted by
sexual glands.
The medulla is separated from the cortex by a thin layer of loose connective tissue
containing sinusoidal capillaries and veins. And between them there are chromaffin cells.
These are glandular rounded cells containing large secretory granules. They produce and
secrete into the bloodstream hormones-catecholamines (epinephrine and norepinephrine).
These substances stimulate the metabolism, namely catabolism, energy production and
heart activity. They cause a spasm of the arteries and increased blood pressure. Adrenaline
enhances vessels of brain and skeletal muscles. Norepinephrine – is the mediator of the
sympathetic nervous system.
In the medulla there are multipolar neurons of the autonomic nervous system.
Paraganglia, as the adrenal medulla, are composed of chromaffin tissue that develops from
simpatoblasts of the neural crest. There are abdominal, aortic, carotid, and intraorganic
paraganglia. Outside they are surrounded by a connective tissue layer which penetrates
between the bands of granular endocrines. The later being 10-15 mm in diameter are oval
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or round in shape and contain specific granules of different sizes. Here the catecholamines
are.
ST.LUKE - PROFESSOR, PHYSICIAN, ARCHBISHOP
Nikolaenko Y., Khlebnikova T., Tkacheva A. - the 3rd year students
Scientific leaders – Doc.Med.Sc. S.I. Piskun, O.I.Katina
Valentin Feleksovich was born in April 27, 1877 in Kerch, in the family of a zealous
Catholic from a Polish noble family. He was fond of painting, but the desire to become a
doctor overcame, and in 1898 he entered the Medical Faculty of the University of Kiev.
Under the influence of his Orthodox mother the future saint becomes Orthodox
consciously, having finished with a brief gust of Leo Tolstoy ideas. During the RussianJapanese War he worked as a surgeon in Chita.
He was the Professor of the Tashkent Medical Institute and the Archbishop. St. Luke
was one of the few whose bronze bust was installed in vivo in the gallery of outstanding
surgeons of our country at the Sklifosovsky Institute of Emergency Care in Moscow. And
he was the prominent church leader entered in the list of the higher clergy of the Russian
Orthodox Church. He is the author of "Sketches of purulent surgery" that awarded the first
post-war USSR State Prize in 1946, and a religious treatise "The Spirit of Samuel the
prophet". He was the doctor brilliantly aware in the anatomy of the human body and the
priest who believed that the soul was placed in the center of the heart. A lot of extraordinary
and controversial things coexisted in the outlook and life of Valentine Feliksovich VoynoYasenetsky. He made a great contribution to the anesthesiology. In 1915 he published his
first monograph "Regional anesthesia" in Petrograd. In 1916 he successfully defended his
doctoral thesis "On the regional anesthesia of the second branch of the trigeminal nerve."
He was the first who described the anesthesia of the trigeminal nerve by introducing
ethanol directly into the trunks of its branches (orbital, mandibular and maxillary), as well
as in Gasser's ganglion.
St. Luke was a physician who treated ordinary people, many of which are still alive;
professor delivered lectures to ordinary students, practicing physicians at present; the
political prisoner who passed prisons and tortures ... and became the winner of the Stalin
Prize; the surgeon who saved hundreds of people from blindness and who lost his sight at
the end of life. He was the brilliant doctor and a talented preacher who often oscillated
between these two vocations, Christian of enormous willpower, integrity and fearless faith,
but who could not avoid serious mistakes in his path. A real man. Shepherd. Scientist.
Saint.
This remarkable man died in June 11, 1961 on Sunday, the day of All Saints
Resplendent in the Russian Land.
ADIPOSITY
Tkacheva A., NikolaenkoY., Khlebnikova T. - the 3rd year students
Scientific leaders – Doc.Med.Sc. N.A. Ishutina, O.I. Katina
Lipids are heterogeneous in chemical composition organic substances that are
insoluble in water but soluble in nonpolar solvents.
One of the standard forms of pathology of lipid metabolism is obesity. The challenge
of obesity in the world is very acute today.
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Obesity is an excessive accumulation of lipids in the body in the form of
triglycerides. It refers to the stromal-vascular fatty degeneration. Adipose tissue may be
preserved as in areas of physiological depots, so as in the area of breast, thighs, and
abdomen.
Depending on the degree of weight gain there are three degrees of obesity. The I
grade of obesity - body mass index is of 25-29.9. Grade II – BMI is 0-39.9. Grade III - a
body mass index is above 40.
According to the predominant localization of adipose tissue they distinguish general
obesity (equable) and local (local lipohypertrophy). There are two varieties of local obesity.
Female type (hynoid) – the excess fat is mainly in the thighs and buttocks. Male type
(android or abdominal) – the accumulation of fat is predominantly in the abdominal area.
On the genesis of obesity they isolated its primary and secondary forms. The cause
of primary obesity is a violation of the regulation of the functioning of the system of lipid
metabolism. Secondary obesity develops when excess caloric food intake and a reduced
level of energy consumption of the body.
There are neurogenic, endocrine and metabolic mechanisms of obesity. The reasons
may be different: a mental disorders manifesting in a constant, sometimes irresistible,
desire of food intake, damage of the hypothalamus neurons, lack or excess production of
certain hormones.
In today's world the problem of obesity is very urgent. According to some research
it is known that overweight people along with obesity acquire a predisposition to serious
diseases such as diabetes, hypertension, myocardial infarction and cancer. Adiposity is
directly connected to some of the most common diseases including hypertension, coronary
heart disease, arthritis, cholecystitis, cancer of breast, prostate and colon. Many obese
people have low self-esteem, depression, neuroses and other psychological problems.
To solve the obesity problem one must consult a doctor, such as an endocrinologist
and nutritionist, to be examined and then to take treatment administered by an expert.
NUTRITIONAL STATUS AS AN INDICATOR OF POPULATION HEALTH
Khlebnicova T., Nikolaenko Y., Tkacheva A. – the 3rd year students
Scientific leaders - D.A. Semenov, O.I. Katina
The study of nutritional status is based on a study of the health status of an individual
as an indicator of the adequacy of nutrition. Generalized characteristics of the health and
dietary habits of a particular person is required to determine the volume and nature of the
medical-diagnostic, dietary and hygienic measures. Methodology for assessing nutritional
status includes the definition of indexes of nutritional function, food adequacy
(identification of signs of food deficiency, excess or imbalance in the diet) and disease.
Incidence is closely connected with nutritional status and various disorders caused
by food intake in particular to insufficient or excessive feeding.
The body needs to receive a huge amount of certain substances from which the cells,
tissues and organs are built. Food should contain proteins, fats, carbohydrates, vitamins,
minerals, water, cellulose, enzymes, flavorings and extractives, minor components bioflavonoids, indoles antotsianids, isoflavones and many others.
The need in the amount of nutrients varies among individuals and depends on sex,
age, physical activity, metabolic state and health.
The basic law for a balanced diet calls the necessity to match the levels of income
and consumption of energy. The reduction of energy consumption leads to a decrease in
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the volume of food consumed. However, in this case the second law of nutrition is violated:
diet of modern man sufficient in calories is not able to cover the body's need for vitamins
and other essential substances.
Thus, it is a violation of the nutritional status that explains the presence in the
population of a large number of persons with overweight and obesity - a leading risk factor
for such diseases as atherosclerosis, coronary heart disease, hypertension, diabetes mellitus
on the one hand; and on the other hand - with reduced immunoreactivity and resistance to
radiation and chemical nature of the contaminants.
B 12-DEFICIENCY ANEMIA
Bak E., Grivtsova M., Makogon K.- the 6th year students
Scientific leaders – Doc.Med.Sc. V.V. Voitsekhovsky, Cand.Med.Sc. S.A. Goryacheva,
O.I. Katina
B12-deficiency anemia (megaloblastic, pernicious) - is a pathological condition
caused by a deficiency of vitamin B12 in the organism. It leads to a violation of the
synthesis of DNA in hemopoietic cells. And it is characterized by the occurrence of
megaloblasts in the marrow and intramedullary destruction of erythrokaryocytes. As a
result hematopoiesis is ineffective. There is an anemia progress combined with
thrombocytopenia and leukopenia. Moreover, cyanocobalamin is a coenzyme in the
conversion reaction of methylmalonyl-CoA to succinyl-CoA. This reaction is required for
the metabolism of myelin in the nervous system. Thereby, with the deficiency of
cyanocobalamin the defeat of the nervous system is marked along with megaloblastic
anemia.
The main reasons for the development of B12-deficiency anemia are:
- Malabsorption of vitamin B12 (atrophic gastritis, gastric cancer, gastrectomy
surgery, resection of the small intestine, celiac disease;
- Increased need in vitamin B12 (tapeworm infestation wide, diverticulosis of the
colon, intestinal dysbiosis, the rapid growth in children, hyperthyroidism, chronic liver
disease);
- Violation of transport of vitamin B12 (deficiency of transcobalamin II (autosomalrecessive inherited defect manifesting in early childhood);
- Violation of use when taking some medications (PASK, neomycin, metformin);
- Alimentary deficiency (a rare cause), mostly in childhood with a prolonged
parenteral nutrition without additional supply of vitamins.
Clinical presentation. Anemic syndrome manifests with weakness, fatigue,
shortness of breath, palpitations.
The syndrome of bone marrow haemolysis - mild jaundice develops as a result of
increased destruction of erythroid cells (ineffective erythropoiesis) due to indirect
bilirubin.
Dyspeptic syndrome manifests with anorexia, glossitis, and "varnished" tongue.
There is the reduction of gastric secretion and atrophic gastritis. As a result of lesion of the
peripheral nervous system (myelosis funicularis) ataxia, paresthesia, hyporeflexia,
Babinski reflex, in severe cases coma and clonus appear. In children of early age
hypotrophy, growth retardation, irritability, chronic diarrheas, susceptibility to infections
develop.
Criteria of B12-deficiency anemia: a high color index; macrocytosis, megalocytosis;
erythrocytes with remnants of the nuclei (Jolly bodies, Cabot's ring bodies);
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reticulocytopenia;
neutrophils
hypersegmentation;
leukopenia
(neutropenia);
thrombocytopenia; megaloblastic hematopoiesis in bone marrow; neurological disorders
and psychiatric disorders.
Treatment. If specific cause of vitamin B12-deficiency is determined, there is an
indispensable etiotropic treatment (dehelminthisation, surgical removal of the gastric
tumors, the treatment of intestinal diseases, dysbacteriosis correction in particular, etc.).
Pathogenetic therapy: when confirmed diagnosis of B12-deficiency anemia, a longterm treatment with vitamin B12 preparations is administered (cyanocobalamin,
hydroxocobalamin). Initially, the drug is injected intramuscular of 1000 mg daily to
normalization of hemoglobin. And a week later the response to therapy is expected
as reticulocyte crisis. Subsequently the supportive therapy 1000-500 mg (1-2 times per
month) is performed.
HISTOPHYSIOLOGY OF LUNG AIRWAYS AT NORM AND AT THE
DEVELOPMENT OF MICROCELLULAR CANCER
Urmancheeva V. – the 2nd year student
Scientific leaders - V. S. Kozlova, O.I.Katina
The airways are the system of tubes and cavities including the nasal cavity with
paranasal sinuses, larynx, trachea and bronchial tree.
These organs are unified by: the presence of cavities, laminar structure of the wall;
the presence of fibro-cartilaginous stroma in the wall that provides yawning lumen; mucosa
is lined with ciliated epithelium; there are special accessories for the producing of inhaled
air (mucous glands, lymphoid formations, blood vascular plexus), ciliated epithelium.
In the initial stage a microcellular lung cancer presents the infiltration of the
submucosal layer manifesting in disappearance of mucosal folding of the main bronchus.
In the later stages a microcellular lung cancer is a gray-yellow node with soft consistency;
in incision multiple foci of necrosis are defined.
During the histological study of tumor node the absence of the layers formation of
tumor parenchyma in the main bronchi is determined. Instead, microcellular lung cancer is
composed of small tumor cells of round or fusoid form.
There are often necroses in the tumor. Mitotic activity of microcellular lung cancer
is approximately 10 mitosis in sight when a significantly increased.
Tumor cells grow by layers, bands, sometimes with the formation of structures
resembling rosula and glands. The stroma is lean. Infiltration with lymphoid cells is usually
absent. There are areas of necrosis.
There are cells in the tumor without manifestations of tissue-specific differentiation
- undifferentiated cells, and cells with specific differentiation features - endocrine,
glandular, planocellular.
THE PROJECTION OF VERMIFORM PROCESS AGAINST THE BODY TYPE
Barannikov S., Damchat A., Kungaa A. – the 3rd year students
Scientific leaders – Cand.Med.Sc. S.I. Piskun, O.I. Katina
Topographic-anatomical features of structure and location of ileocecal angle are of
great practical interest as differences in position of the vermiform process impact the
clinical symptomatology and course of the disease. The study of anatomic variants in
appendix’s location in the practical medicine helps to interpret the data of clinical
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examination and optimize operational and technical tasks. Anatomical variability
correlates with the individual body type.
There are following types of body structures by V. N. Shevkunenko:
1) Dolichomorphic type is characterized by high stature, weak muscles and skeleton,
minimal fat;
2) Mesomorphic type – a person has an average stature, well developed skeleton
and muscles, the best proportions of the body, limbs and head, weak deposition of
subcutaneous fat;
3) Brachymorphic type is characterized by medium or low stature, short neck and
large size of the head, short limbs, a broad chest and a tendency to the deposition of
subcutaneous fat.
The most people have a mixed form of constitution.
In individuals with dolichomorphic somatotype the location of the appendix is:
• 56.25 % retrocecal location - the appendix lies behind the cecum;
• 31.25 % upward or subhepatic location - the appendix’s tip has an upward position,
often to the subhepatic recess;
• 12.5 % — retroperitoneal location.
Individuals with brachymorphic somatotype most often have pelvic or downward
location of the appendix. The process is directed downward into the pelvic cavity.
In persons with the mesomorphic type the location of the appendix is typical.
Acute appendicitis remains to be the most frequent cause of “acute abdomen”
requiring surgical intervention. In Russia surgical intervention for acute appendicitis is
performed to 1-1.5 million patients yearly.
It is usually assumed that the base of the vermiform process is projected at the MakBurnea point or Lanza point. In fact, due to differences of the appendix and the caecum
locations the projection is only 7.6 % at the Mak-Barnea point (on the border of lower and
middle thirds of the line connecting the umbilicus with the anterior upper spine of the
ilium). And it is 20 % at the Lanza point (on the border of middle and right third of the lin.
Biiliaca) (V. I. Kolesov, 1972). In 29% the base of the appendix is 3.25 cm above the point
of Mak-Burnea, and in 70% it is 2.8 cm below this benchmark (Maksimenkov A. N., 1972).
Thus, it is necessary to take into account the body type of the patient during surgical
intervention.
LIPID PEROXIDATION (LPO). LPO IN PREGNANCY
Damchat A., Barannikov S., Kungaa A. – the 3rd year students
Scientific leaders – Doc. Med. Sc. N.A. Ishutina, O.I. Katina
The reactions of lipid peroxidation (LPO) are free radical reactions and they are
constantly occurred in the body. Fatty acids containing double links located through CH2group are the most vulnerable to the action of active oxygen forms. Free radical (initiator
of oxidation) easily takes an electron from CH2-group and transforms a lipid containing
this acid in a free radical.
Stages of lipid peroxidation:
1) Initiation: the formation of free radical (L•)
Hydroxyl radical most often initiates the reaction. It takes hydrogen from the CH2groups of polyene acid, which leads to the formation of a lipid radical.
2) Development of chain:
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The development of the chain is due to the adjoining of O2. As a result
lipoperoxiradical LOO• or lipid peroxide LOOH are formed.
LPO is a free radical chain reactions, i.e. each formed radical initiates the formation
of several others.
3) Destruction of the lipid structure.
The final products of peroxide oxidation of polyene acids are malonic dialdehyde
and the acid hydroperoxide.
4) Chain termination – an interaction of radicals among themselves.
Hydroperoxides of lipids, free fatty acids and phospholipids-amphiphile are
accumulated as a result of activation of lipoperoxide reactions and hydrolases.
Accumulated products are fixed in the hydrophobic and hydrophilic areas of a membrane.
It leads to the formation of the vast amphiphilic clusters, to the microreserve and
destruction of the membrane.
In physiological conditions LPO is a necessary mechanism to update the
phospholipids of membrane structures.
Significant increase of the peroxidation level in comparison with the norm is a
characteristic symptom of many diseases: muscular dystrophy (Duchenne's disease),
Parkinson’s disease, etc.
Also the increasing of LPO levels occurs in women during pregnancy, as there is a
significant restructuring of women’s organism activity during pregnancy. It is associated
with changes in the system of blood, endocrine, immune systems and with the change of
total state of an organism. The number of radicals affecting the tissues and organs of a
pregnant woman, as well as cells of the placenta and embryo increases.
The reasons for the free radicals increase during pregnancy are:
• Participation of free radicals in the progesterone synthesis;
• Hypoxia;
• Disorder of oxidation-reduction processes;
• Inhibition of antiperoxidative protection mechanisms;
• Increase in the number of Pro-oxidants;
• Excitation of adrenergic structures of the hypothalamus during stress (adrenaline,
cortisol) that leads to a decrease of blood antioxidant capacity;
• Exposure of adverse environmental factors: air pollution, tobacco smoke, UV
radiation etc.;
• Pregnancy pathologies: herpes, chronic nonspecific lung diseases, iron deficiency
anemia, preeclampsia, preeclampsia, extragenital diseases.
SAMPLING OF AIR AS METHOD OF HYGIENIC LABORATORY RESEARCHE
Kungaa A., Barannikov S., Damchat A. – the 3rd year students
Scientific leaders – Cand. Med. Sc. D.A. Semenov, O.I. Katina
Sampling of air requires the presence of qualified specialists of laboratory service.
But to assure the quality of these studies in a number of provisions there is a need in
participation of hygienists.
Depending on the magnitude of substances concentrations determined in air,
sampling can be carried out without pre-concentration or with pre-concentration with the
help of special devices. The choice of option is determined by the sensitivity of using
methods and analytical instruments.
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If the concentration of a substance in air is in a sensitivity range of the measuring
complex (method + device), it is enough to provide selection the required amount (volume)
of air samples according to the regulated procedure. If the concentration of a substance in
the air is much smaller than the lower bound of the sensitivity of the method, one should
catch (concentrate) the substance in a selective environment by pumping large volumes of
air. Only after this the analysis is performed by the regulated method. And the calculation
of concentration is performed basing on conditions of carried out sampling.
Sampling of air in the production premises is carried out directly in the breathing
zone, i.e. at a height of 1.5 m from the floor surface. However, for expanded view about
the character of migration of toxic components, it is advisable to carry out sampling of air
in addition - at the same point, at heights of 0.25 m and 1.7 m. During the study of several
workplaces in one manufacturing room it would be advisable to perform additional
sampling in the "background" point equidistant from all sources of air pollution of the
working area. It allows assess more objectively the condition of the air environment in the
workplace.
Sampling the air without pre-concentration.
Sampling the air without pre-concentration may be carried out in gas syringes and
pipettes by injecting or pumping the probed air through the aspirator. Also the air must be
skipped through the vessel in amount no less than in 10 times more than the volume of the
intake device. During sampling air with a syringe it is necessary to perform the same
number of dummy pumping.
Sampling air in a similar way may be produced in sealed plastic containers and bags
of required capacity. Such bags must be manufactured from materials having minimum
sorption capacity of the inner surface and reaction-ability, good integrity, allowing for
hours to keep the air sample without significant changes in its composition and properties.
For making gas chromatographic studies of aromatic hydrocarbons the sampling of
air can be produced in steel tanks. As in this case it is registered their smaller sorption on
the surface of the vessels in comparison with glass container. In this case, it is expedient to
use for the discharge air the membranous compressor.
The selection of air samples with pre-concentration.
Sampling air with pre-defined concentration of substances in gaseous or vaporous
state can be captured by several methods. Recovery through absorption devices filled with
liquid absorbing areas is most traditional.
Solid sorbents can be used as sinks. Chemicals contained in the air as aerosols can
be focused using filters. If the analyzed substance is at the same time in form of aerosol or
steam in the air, it is needed to install an optional filter on the input before the absorption
device. Further on the substance from filter and absorber are selected and defined
comprehensively. Choice of concentration technology should be based on desire to ensure
maximum absorption of the analyze substance.
BASIC DATA OF ONCOUROLOGICAL SITUATION IN THE AMUR REGION
Murashko S. – the 5th year student
Scientific leaders - Prof. L.N. Voight, O.I. Katina
Malignant tumors (MT) of the genitourinary system organs are not leading in the
structure of cancer incidence. But the increase in the absolute number of cases and a
significant growth rate of pathology of this type cannot be ignored.
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Malignant neoplasms are one of the leading causes of death and disability in the
population of Russia and in the Amur region for the last 15 years. Currently the Ministry
of Health of the Russian Federation and the Russian Association of Oncologists has taken
serious steps for the protection of health among the population of our country, particularly
in the development of oncology service.
Oncology – is a multidisciplinary part of medicine that deals with the doctors of
different specialties. Among the total cancer incidence in the Russian Federation
neoplasms of the urogenital system (kidneys, bladder, prostate gland) comprise 11.5%. In
comparison with 2010 there is a registered increase in 17.5% of the absolute number of
cases. In the Amur region 567 people died of cancer of the genitourinary system in 2010 –
2015 years. That is 8.0% of the total number of deaths from cancer over this time period.
From 2010 till 2015 1166 new cases of the genitourinary system malignancies
(cancer of the kidneys - in 455 persons, prostate cancer - in 363 and bladder cancer - in 348
people) were diagnosed in the region.
Kidney cancer is detected in 40% of patients in the general structure of cancer
incidence in the Amur region. The difference in number between the male and female
population with kidney cancer is virtually unchanged for the last five years. It ranges from
40.7% in 2010 to 51.2% in 2015 in women and from 48.8% in 2010 to 59.3% in 2015 in
men. The proportion of patients of reproductive age is 3.5%. The peak of incidence occurs
in the 45-55 years old (67.9%).
Indicator of bladder cancer was 10.1 per 100 thousand of population. Among all the
cases male patients prevailed. The peak of incidence occurs in the 50-59 years old (71.3%).
Prostate cancer is registered in 363 men during this period. The incidence of this
type of MT increased from 17.5 in 2010 to 21.3 per 100 thousand of population in
2015. The peak of incidence is in 55-65 years old (63.7%).
COMPARATIVE CHARACTERISTICS OF THE HEALTH CARE SYSTEM IN
RUSSIA AND SOME FOREIGN COUNTRIES
Blokhina E., Solonin A. – the 5th year students
Scientific leaders – Doc. Med. Sc. L.N. Voight, O.I. Katina
Modern Russian health care system is constantly exposed to harsh criticism: free
medicine is less effective, and the paid one – is more corrupt. Some drug prices are too
increased and to get some imported medicines is almost impossible. According to many
experts Russia should take foreign experience and conduct health care reform using the
examples of other countries. But if is it necessary to follow the examples of health care
systems of foreign countries?
The health care system in each country is a product of its unique characteristics,
history, political process, and the national character of the people. Many of these systems
undergo great reforms at present.
Now most countries face with the problem of rising costs on the health care system.
This in turn leads to an increase of taxes and increase in the cost for health insurance.
A careful study of the situation shows that the health care system in almost all
countries of the world are facing with the problems of rising costs and inaccessibility of
health care for the part of the population.
In those countries focusing the governmental control over health care system
citizens are most likely to face a "waiting list", valuation services, restrictions on the choice
of the doctor and other obstacles in the field of health care.
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The presence of health insurance does not mean the overall access to health services.
In practice, in many countries almost every citizen has insurance but medical services are
“metered” within this insurance or people have to wait for treatment in line for a long time.
Countries with more effective health care systems achieve a similar result by
eliminating the centralized state control and reliance on market mechanisms - competition,
separation costs, market prices and choice for consumers. This is not the abolition of
universal health insurance. But a departure from the centralized state control and passage
of public health to a market basis should be recognized as the dominant global trend.
PALMITIC ACID
Ionova N. – the 2nd year student
Scientific leaders – Cand.Biol.Sc. G.K. Doroshenko, O.I. Katina
Palmitic acid or hexadecanoic acid in IUPAC nomenclature is the most common
fatty acid (saturated) found in animals, plants and microorganisms. Its chemical formula is
CH3-(CH2)-14COOH. As its name indicates, this acid is the major component of the oil
from palm trees (palm oil). But it can also be found in meat, cheeses, butter, and dairy
products. Palmitate is a term for the salts and esters of palmitic acid. The palmitate anion
is the observed form of palmitic acid at physiologic pH (7.4).
Aluminium salts of palmitic acid and naphthenic acid were combined during World
War II to produce napalm. The word "napalm" is derived from the words naphthenic acid
and palmitic acid.
Palmitic acid is naturally produced by a wide range of other plants and organisms,
typically at low levels. It naturally presents in butter, cheese, milk and meat as well as in
cocoa butter, soybean oil and sunflower oil. The cetyl ester of palmitic acid (cetyl
palmitate) occurs in spermaceti.
According to the World Health Organization evidence is "convincing" that
consumption of palmitic acid increases the risk of developing of cardiovascular diseases.
Theses evidences are based on the results of studies indicating that palmitic acid may
increase LDL levels in the blood. Retinyl palmitate is an antioxidant and a source of
vitamin A added to low fat milk to replace the vitamin content lost through the removal of
milk fat. Palmitate is attached to the alcohol form of vitamin A and retinol to make vitamin
A stable in milk.
Rats fed in a diet of 20% palmitic acid and 80% carbohydrate for extended periods
showed alterations in central nervous system control of insulin secretion, and suppression
of the body's natural appetite-suppressing signals from leptin and insulin (the key hormones
involved in weight regulation).
MELANOMA METASTASIS
Chernushevich D. - the 3rd year student
Scientific leaders – Doc.Med.Sc. I.Y. Makarov, A.I. Patrakov, O.I.Katina
Ways of development and types of melanoma metastases.
Melanoma metastases are known to affect any organs while spreading. But
according to the observations of oncologists there are organs exposed to degeneration more
often than other organs. That is why speaking of metastasis we mean primarily the
melanoma metastases in the lymph nodes and lungs. A little less than these organs (but still
often enough) liver and the brain are exposed to metastasis.
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Physicians identified the following ways of metastasis of melanoma:
• lymphogenous;
• hematogenous;
• mixed.
For nodal metastasis the infiltration of tumor cells into the lymphatic vessel is
characteristic. Further on with the lymph flow they spread in distant and near lymph nodes.
This way of scattering is the most characteristic for melanoma.
Hematogenous way, i.e. the spread of cancer cells of the affected organ in a healthy
one through the blood flow, contributes to the spread of the affected cells in various distant
organs: liver, lungs, brain, bones, kidneys, adrenal glands. There are varieties of melanoma
with high malignancy potential and tendency to early hematogenous metastasis.
Types of metastases:
1. Satellites. They look like multiple rashes spots of color of the tumor, which are
located in close proximity to the initial focus of the disease (or at a slight distance from it).
2. Nodular form. In this form cutaneous metastases appear as multiple subcutaneous
nodes of different sizes. They can be located at any distance from the initial tumor.
3. Erysipelatous form. This kind of skin metastases presents area of swelling bluishred skin that surrounds the tumor.
4. Trombotsitopaty form. This is a radially extending painful seal with an enlarged
superficial veins and swelling of the skin around the melanoma.
Recurrence of melanoma metastasis.
Metastases in melanoma tend to be cyclical in growth and expansion. While the first
case may completely regress (to fade) and it even will not be detected on repeated
examination. Observations of physicians showed that if the thickness of each of the
metastases is less than 0.7 mm, there is a high expectancy that these metastases will not
further progress. If the thickness of the metastases has reached the size of 1.5 mm, this may
indicate that the patient is at risk. In such cases the relapse usually manifests in the first
three years. Therefore, it is so important for patients with melanoma to undergo regular
checkups with an oncologist after he was diagnosed melanoma metastases.
LEAD POISONING
Lopsan A. – the 4th year student
Scientific leaders – Cand.Med.Sc. S.A.Goryacheva, O.I.Katina
Lead is malleable and relatively refractory metal with silvery shimmer. Lead and
many of its compounds are used in industry, in the production of crystal glass, as well as
paints (white ceruse, red lead), and others. They can be found in everyday life during food
intake that was kept in ceramic ware for a long time. Professions with an increased risk of
lead poisoning include: agriculturists, ore miners, lead smelters, Battery attendants, lead
powder millers, lead products chasers and solder workers. Lead affects the nerve cells and
the myelin coat. It blocks the activity of these cells (replaces the calcium and magnesium
in the processes of cell metabolism and cell reproduction process, the myelin sheath
disappears). Accordingly, the nerve cells suffer from a lack of nutrition, dies off quickly
and the nerve impulses are carried slower.
Laboratory signs of chronic lead poisoning: reticulocytosis, reduce of red blood cell
levels, basophilic stippling of red blood cells, and the appearance of coproporphyrin and
aminolevulinic acid in the urine, an increase of the concentration of erythrocyte
protoporphyrin, aminoaciduria, glucosuria and high lead level in blood and urine.
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For the treatment of chronic lead intoxication chelators are used - sodium calcium
edetate and Pentacinum. During the initial forms of intoxication, after finishing the
treatment it is recommended temporary transfer to a work without a contact with the lead
for 1-2 months, then – the return to the former work. At the expressed forms of intoxication,
even after the complete regression of the saturnism manifestations after the conducted
hospital treatment, the contact with the lead must be ceased permanently.
TRISOMY 8
Demko A. - the 5th year student
Scientific leaders – Cand. Med.Sc. E.L.Chupac, O.I.Katina
At present there is an observed increase in the frequency of chromosomal diseases
in Russia. Among children population it was 0.6% in 2014. Chromosomal mutations are
often the result of newly emerging genomic mutations at the blastula stage. Its frequency
is random and does not depend on any factors. Diagnosis is difficult due to the faintness of
the clinical picture. Trisomy of chromosome 8 is referred to such diseases. The frequency
of such chromosomal abnormalities in newborns is 1:5000 with a predominance of boys.
For this disease the most characteristic abnormalities are in the facial structure of
musculoskeletal system and defects of the genitourinary system. In clinical examination of
newborns the multiple stigmas of dysembryogenesis (for example, deep-set eyes,
hypertelorism of eyes and nipples, high palate, thick lips, inverted lower lip, big ears with
thick leather, etc.) are revealed. According to additional studies there are malformations of
the urogenital system and the heart, and in x-ray diagnostics the defects of the skeletal
system are seen.
Clinical case
The child was admitted from the maternity hospital to the hospital department of
pathology of newborns and preterm infants at a 3 day of his life with a diagnosis of:
Omphalitis. He had mitral valve insufficiency of II degree, the syndrome of depression,
multiple stigmas of dysembryogenesis, and polycystic kidney disease.
Pregnancy was with toxicosis and gestational edema. Timely delivery with uterine
inertia. Cesarean section. Full-term fetus was born with an Apgar score of 6 points, weight
3200.
At admission the infant: does not suck, poorly keeps heat, requires additional
oxygenation, has convulsive syndrome, in the heart systolic noise is auscultated. The child
has a long body and limbs, prominent forehead, flat occiput, short neck, broad nasal bridge,
large nose, full lips, inverted lower lip, high arch of the sky, micrognathia, low-set and
deformed ears, hypertelorism nipples, fourfingery crease on right palm, hypertrichosis,
wide hands and feet, camptodactylia, aplasia of patella, contractures in the joints, inguinal
hernia, cryptorchidism, hypoplasia of the prepuce.
Ultrasound examination revealed: the change of architectonics of the kidneys,
enlargement of the left hilus, defects of the interventricular septum and the expansion of
the ventricles of the brain.
Basing on the combination of multiple stigmas of dysembryogenesis with internal
malformations of the circulatory and urogenital systems the presence of chromosomal
pathology in a newborn was suggested. The cytogenetic survey was made. The genotype
47XY, +8/46, XY, was identified. The ratio of clones was 75:25. Diagnosis: Trisomy 8.
Mosaic form.
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In 2 months the child was transported to the neurological department for further
treatment.
The prognosis for this disease is unfavorable. Further mental retardation,
hydrocephalus, cryptorchidism, contractures, aplasia of the corpus callosum and other
changes develop.
After diagnosis of a genetic disease it is necessary to arrange medical-genetic
consultation to a family. There are no restrictions for a further delivery as a chance of birth
of children with this form and other chromosomal diseases in such parents is not increased.
However, if the woman's age at next pregnancy exceeds 35 years, the prenatal diagnosis at
age reasons is necessary – ultrasound and cytogenetic examination of the fetus.
BORDERLINE NEUROSIS
Chenchenko V., Lopsan A. – the 4th year students
Scientific leaders – M.I. Bugrova, O.I. Katina
Neurosis is a condition caused in most cases by a long and hard experienced stressful
situations that tearing the psychological adaptation cause depletion of the nervous system
(a combination of irritability and fatigue), anxiety and vegetative disorders (sweating,
palpitations, malfunction of the stomach, etc.).
The main manifestations of neurosis: high sensitivity to stress – people react with
despair or aggression, tearfulness, resentment, vulnerability, anxiety, quick tiredness at
work – reduced memory, attention, thinking ability, sensitivity to loud sounds, bright light,
temperature changes, sleep disorders. Very often it is difficult for a person to sleep well
because of overexcitation; sleep is superficial, anxious, not bringing relief; there is often
drowsiness in the morning.
Vegetative disturbances: sweating, rapid heartbeat, fluctuations in blood pressure
(usually downward), a disorder of the stomach, sometimes – decreased libido and potency.
People of creative professions, mainly actors, are more susceptible to neurosis due to the
frequent changes of the images of their characters. Ranking members, athletes, military
officers, teams of special purpose may also be exposed to it.
Restorative therapy, physiotherapy, and vitamin therapy take an important place in
complex treatment of neuroses. Nootropic drugs (nootropics aminalon) were widely used
for the treatment of asthenic states in the last decades. Many neurotic symptoms are well
cropped with various tranquilizers (phenazepam, Librium, valium, tazepam) or small doses
of some neuroleptics (chlorpromazine, neuleptil), with drug therapy, diet therapy, music
therapy, bibliotherapy.
CONSEQUENCES OF EMERGENCY SITUATIONS AT TYPHOONS
Kross D. – the 2nd year student
Scientific leaders - O.I.Katina
Typhoon – is a type of tropical cyclone typical for the north-western part of the
Pacific Ocean. In the central part of typhoons the largest decline of air pressure on the
surface of the sea is observed. It reaches 650 mm Hg.
As a rule typhoons are puffed to the shores of the Russian Far East after Korea,
Japan and the Ryukyu Islands have taken their main blow. Kuril Islands, Sakhalin,
Kamchatka and Primorsky Krai are most susceptible to typhoons.
Typhoon "Layonrok" Japan 2016.
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Due to the typhoon in Japan 110 domestic flights were canceled. Thousands of
houses in the north-western part of the country were without light. In 920 schools classes
were canceled. Due to the bad weather ferry service between Honshu and Hokkaido was
also temporarily suspended.
Typhoon "Layonrok" Primorsky Krai 2016.
Typhoon "Layonrok" struck the Primorsky region, led to the loss of the three-month
norm of precipitation in the east and south of the region. As a result homes were flooded,
bridges and roads were damaged. Influence of typhoon "Layonrok" on Primorsky weather
lasted four days. The damage from the typhoon was 1.2 bln. rubles.
Typhoon "Megi" Taiwan 2016
The victims of typhoon "Megi" in Taiwan were 4 people, 527 were injured, 11500
people were evacuated, and nearly 3000 of them were housed in temporary shelters.
Element has left 3.8 million homes without electricity and 300000 homes were without
water. And in China Typhoon "Megi" brought torrential rains to the eastern provinces. In
many areas there were floods and landslides.
Typhoon "Goni" Ussuriisk 2016.
15 houses and more than 380 town houses were flooded. Five villages were under
the water and about 500 homes were flooded. More than 100 people were evacuated from
villages. Fortunately there were no human victims.
USE OF SUCCINATES IN SPORT
Dubeiko I., Lopsan A. – the 4th year students
Scientific leaders – Doc.Biol.Sc. N.V.Simonova, O.I.Katina
Succinic acid –is limiting dibasic carboxylic acid, colourless crystals soluble in
water and alcohol. It is used in food industry for food production. Foods with succinic acid
is intended for people exposed to high loads - athletes, miners, pilots, sailors, machinists,
drivers, artists, and those who adhere to a healthy way of life. Currently, in order to achieve
the athletic goal — an Olympic medal or a perfect physical form — just the training process
is not enough as physical exertions have reached a high level in modern sport.
The use of drugs is shown to improve the immune system and help to adapt to
physical stress, accelerate recovery processes, prevention and treatment of functional
disorders. In addition, it has beneficial effects on the heart providing it with the necessary
energy and oxygen. But there are contra-indications for the use of this remedy. It is
forbidden when high acidity, severe kidney disease, stomach ulcers.
A course should be started with 500 mg of succinates every day in the morning after
eating, so as not to irritate the mucous membrane of the stomach. Athletes, assessing their
physical condition and emotional status, often choose individual succinates doses. During
the course of application of succinic acid it is necessary to arrange pauses in certain days
(for example, 1-2 days of pause in every 3 days of usage). This method of application of
the drug allows to extend the course, and hence the effect of it.
ANTHRAX IN YAMAL
Skrypnik A., Murashov E., Abdulazyanov D. – the 2nd year students
Scientific leaders – Cand.Biol.Sc. L.A. Guba, O.I. Katina
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From 29 July specialists of chemical protection units found and burned the remains
of 2572 animals that died from anthrax. The soldiers also carried out disinfection of
contaminated soil with bleach over an area of 225 square kilometers.
In 16 August 74 people, delivered earlier from the quarantine zone, were discharged
from Salekhard District Hospital.
4429 district dwellers and 149000 animals were vaccinated till 15 August.
About 500 people and 60 enginery units were involved to eradicate the epidemic of
anthrax.
July 25 there was quarantine due to anthrax in Yamal region. More than 2.3
thousand deer died of it. 90 people were hospitalized in Salekhard district hospital with
disease suspicion. The diagnosis was confirmed in 20 of them.
The presumed cause of infection was abnormally high temperature for the region. It
was known about the death of 12-year-old boy from the intestinal form of the disease in
August 1. The focus of the disease was localized in August 2.
Anyone can be vaccinated against anthrax: ninety thousand doses of vaccine were
taken to the region. However, nomadic herders refused to consider anthrax as a real threat.
CHOLELITHIASIS
Subonov G., Murashov E. – the 2nd year students
Scientific leaders – L.G. Tertichnaya, O.I. Katina
Cholelithiasis is a disease characterizing with formation of stones in gallbladder,
rare in bile ducts.
Cholelithiasis is a wide – spread disease. According to pathoanatomical research
every fifth woman and every tenth man, who died of different reasons, have the stones in
gallbladder. But clinical manifestations of this disease are found only in 10% percent of
people, mostly in woman at the age of 40.
Considerably cholelithiasis is often met among fat women. Passive lifestyle,
pregnancy, systematic overeating, and various factors contribute the stagnation in the
gallbladder and lead to the stones formation in a gall bladder. Cholelithiasis often occurs
in people who have had infectious hepatitis.
There are three main groups of stones. They differ in chemical compounds.
Cholesterol stones are usually single and have white or yellowish colour, round or oval
shape. In the incision they are of radient structure due to radial location of cholesterol
crystals. Pigment stones consisting of bilirubin and calcium carbonate are also met. They
are small and numerous, have various shape, thick but fragile. If staying in the gallbladder
for a long time, the stones may lead to atrophy and sclerosis of the gallbladder due to
mechanical effect to the mucosa.
Etiology and pathogenesis. Cholelithiasis must be seen as a metabolism violation.
And its formation is as a result of these disturbances. The problem of stone formation
mechanisms is not decisively solved. At present cholelithiasis development is thought to
be caused due to three factors: destroy of metabolism, infection and bile stasis. As a rule
the stones contain calcium bilirubinate, cholesterol monohydrate, amorphous and crystal
carbonate calcium. But various people have different content of these substances.
Hypercholesteremia and increased concentration of cholesterol in bile is proved to
contribute the formation of cholesterol stones. Formation of pigment stones is often met
(in 30-70% situations) because of hemolytic processes in the body.
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Prevention of cholelithiasis is in eliminating the causes contributing to bile stasis
and metabolic disorders. So, regular foods, gymnastics, remove constipations, timely
treatment of inflammatory diseases of bile excretory system is recommended.
ZIKA FEVER
Zeinalov O., Bugreeva T. - the 5th year students
Scientific leaders - A.V. Gavrilov , O.I. Katina
According to the WHO the epidemic situation by Zika fever was complicated in
Brazil and other South American countries since March 2015. At 25.03.2016 the infection
was registered in 46 countries of the North America, South America and Asia-Pacific
Region. 16.02.2016 the first case of the Zika fever was confirmed in Russia. It was a 36
years-old woman from Moscow who had vacations with the family in the Dominican
Republic. At the same time the first case of Zika fever was registered in China. In 2015
they reported about first 3 laboratory-confirmed deaths from the disease in Brazil.
Zika fever – is an acute anthropo-zoonotic, natural-focal, arbovirus, transmitted
diseases caused by ZIKV. It proceeds with moderate intoxication and specific exanthema.
Carriers of the virus are mosquitoes of Aedes genera. Reservoir: apes and humans. The
fact of the sexual transmission of the virus from a person to person was determined (in
2009 in the United States from Africa, in 2016 in France from Brazil). There is a high
degree of probability of vertical transmission (transplacental). The infection is supposed to
occur through blood transfusions.
The incubation period of the first disease caused by ZIKV is up to 10 days.
The first signs of Zika fever: headache, pain in muscles and joints, pain in the eye
orbits, conjunctivitis, intolerance of bright light, raising the temperature to 38.5 C and
progressive itchy maculo-papular rash. At first, the rash appears on the face and neck. Then
it spreads throughout the body. New eruptions continue for the first three days and the fever
lasts about five days. The temperature is then normalized and there is only a rash, which
also gradually disappear. Generally, the disease has mild (80%) or moderate (20%) clinical
form and terminate with the recovery. Zika virus affects the human fetus in utero.
Infection of women with Zika fever in the first three or four months of pregnancy
leads to fetal abnormalities, including microcephaly of newborns. During the epidemic in
French Polynesia 73 cases of Guillain-Barre syndrome and other neurological disorders
were revealed. They may be associated with the Zika virus.
Diagnosis is based on clinical and epidemiological data, and serological tests:
ELISA, PCR. At present there are no specific methods of treatment and prevention of the
disease. But active investigations are carried on, including in Russia. Due to the high
population migration, especially during the holidays, and the active development of
tourism the fact of emergency of the virus in the Far East and in the Amur region, in
particular, is not excluded.
EFFECTIVENESS OF COXARTHROSIS AND GONARTHROSIS TERATMENT
IN THE AMUR REGIONAL CLINICAL HOSPITAL
Bugreeva T., Zeinalov O. -the 5th year students
Scientific leaders - Cand. Med. Sc .E.A.Sundukova, O.I. Katina
Degenerative-dystrophic lesions of large joints are among the most common
diseases. And their frequency shows a tendency to further increase.
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The reason for this is not only an increased life expectancy of mainly developed
countries, but also hypodynamia, overweight, emotional stress, and reduces of the
compensatory capacity of the organism. Previously a deforming arthrosis considered to be
a share of elderly people. Now this view is subjected to serious review. 30% of patients
with osteoarthritis are only 40 year old. At the age of 60, osteoarthritis occurs in every
tenth man, but after 70 years it is in every fifth.
In 2013, the department timely and accurately fulfilled the state order to provide
high-tech medical care for orthopedic patients through Federal quotas (140 quotas). As a
result 110 extra endoprosthetic appliances of hip and knee joints were made. And 30
reconstructive plastic surgeries were performed. Complications occurred in 10 patients
(10%).
In 2014, the department also fulfilled the state order to provide VMP to orthopedic
patients by Federal quotas (150 quotas) timely and accurately. This year 130 extra
endoprosthetic appliances of hip and knee joints and 30 reconstructive plastic surgeries
were made. In 2014 the total number of operations performed was 172 endoprosthetic
appliances of hip and knee joints. It is 44 endoprosthetic appliances more than in the
previous year. Complications were observed in 5 patients (3.3%).
It should be noted that a number of quotas was increased in 9.3% in 2014. The
number of complications was reduced to 3.3%.
In 2015, the department timely and accurately performed the state order to provide
VMP to orthopedic patients by Federal quotas (150 quotas), resulting in additional 110
endoprosthetic appliances of hip and knee joints. Also 40 reconstructive plastic surgeries
were done. Complications were observed in 3 patients (2.1%). It is worth noting a positive
trend in reducing the number of complications.
Thus, the experience of endoprosthetic appliances may be considered as positive.
And proximate results up to 5 years of primary endoprosthetic appliances of hip
arthroplasty are satisfactory.
COMPARATIVE CHARACTERISTICS OF DEPRESSION LEVELS OF THE
FIRST AND FIFTH YEAR STUDENTS OF FSEI HE AMUR SMA MH RF
Yatsenko E., Poplavskaja A. – the 5th year students
Scientific leaders - Cand.Med.Sc. E.A. Sundukova, O.I. Katina
State of health of university students attracts an increased attention of specialists
from various fields of medicine. This is due to the role played by this social group in the
society. Among the problems related to the protection of health of students a significant
place is occupied by the neuro-psychiatric disorders. When comparing the mental health
of different groups of the population it turned out that the problem is most acute in relation
to students.
The intense way of life and learning has high requirements to the compensatory
mechanisms of the psyche. Their failure leads to stress, psychological and social conflicts,
and depression. Do not forget about the time factor, because the educational
maladjustment, even on a relatively non-durable period, results in permanent retard with
training schedule and, therefore, to a prolonged depression. In terms of prevalence the
anxiety and depressive disorders rank first among mental disorders and occur in 10-12%
of the general population; 4% of the population suffers from chronic forms of this type of
pathology.
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We decided to evaluate and compare the levels of depression in students of the first
and fifth year of FSEI HE Amur State Medical Academy of the RF Ministry of Health.
In the Amur State Medical Academy students of the first and fifth year were tested
by Beck Depression Inventory. The total number comprised 80 students, including 40
students of the 1 course and 40 students of the 5th year of study. Assessment of the level
of depression was carried out on a voluntary basis and was absolutely anonymous. Each
respondent was informed in advance about the rules of filling in the Beck Depression Scale.
After receiving the results of the test (0-9 - no depressive symptoms, 10-15 - mild
depression, 16-19 - moderate depression, 20-29 - severe depression, 30-63 - severe
depression) we conducted a statistical analysis of the material.
According to the results of Beck Depression Scale it was revealed that:
There were no significant differences in levels of depression between the first and
the fifth year students (p> 0.05). It may be associated with a small sample of the study.
While according to the literature an increased tendency to depression is diagnosed in the
first year students because of the strain of compensatory mechanisms of neuropsychological regulation, followed by their depletion in senior years.
Basing on the calculation and analysis we obtained the following:
1. The absence of depression was found in 37 persons out of 80 - 46.25% of the tested.
19 students were exposed to mild depression - 23.75%.
Moderate depression was noticed in 6 students - 7.5%.
Expressed depression was in 10 people - 12.5%.
Severe depression was in 1 student - 1.25%.
2. Results for 1st year students:
Of the 40 tested students 13 of them had no signs of depression - 32.5%, in 14
persons a mild depression was stated - 35%, moderate depression was in 3 individuals 7.5%, expressed one was in 9 cases - 22.5%, severe persisted in 1 student - 2.5% .
3. Students of the 5th year:
In 24 of the 40 tested students no signs of depression were marked - 60%, 8 persons
revealed a mild depression - 20%, moderate depression was in 5 people - 12.5%, expressed
one was in 3 individuals - 7.5%, there was no severe depression in any of the investigated
students - 0%.
Comparing the results of the 1 and 5 year students it is seen that the first year
students are more exposed to depression than students of the 5th course.
INFARCTION OF THE LUNG. CAUSES AND CONSEQUENCES
Triukhan V., Gubershtro Y. - the 3rd year students
Scientific leaders – A.I. Patrokov, O.I. Katina
Pulmonary infarction is a complication that develops as a result of the effect of
certain causes - thrombotic occlusions in the system of pulmonary blood flow. Pulmonary
infarction is accompanied by the rapid development of the process.
The main cause for the development of pulmonary infarction is an enhanced
thrombus formation in the blood vessels of the body. The most frequent reasons leading to
pulmonary infarction are numerous thrombophlebitis, thrombosis of the vasculature of
veins of the lower extremities, traumatic lesion of tubular bones that can cause fat
embolism of certain vessels of the pulmonary network. Surgeries, especially on the veins
of the limbs, can also easily lead to ischemia of the lung and heart attack.
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If the occlusion appears in a major pulmonary vessel, most often thromboembolic
lose ends with the death of the patient. If there is no timely stop and treatment of an attack
of pulmonary infarction, complications may be quite severe. Pneumonia is the most
frequent complication of pulmonary infarction as on its background the necrotic changes
are formed in the lung. Thereby it creates favorable conditions for the growth and
multiplication of various pathogenic microorganisms. Abscesses develop — filling with
purulent and necrotic masses of the lung tissue cavities. There is the threat of its rupture
and entering of the content in healthy parts of the organ. Also myocardial abscesses can
lead to spontaneous pneumothorax that leads to pathological changes of respiratory
function. The lung abscess is considered to be the most severe consequence of heart attack.
The classic consequence of pulmonary infarction is the scarring of the lung. In some
time the area exposed to severe hypoxia is supplied by connective tissue. This results in
the formation of post-infarction scars. Dense connective tissue is formed from 3 to 4
months after the attack. After that the patient suffers from: stertorous inhalation; severe
shortness of breath in slight exertion; cyanosis of the skin under the nose; dry rales. If do
nothing for a long time, the disease will develop into cardio-pulmonary insufficiency. And
it will significantly worsen the quality of life of the patient.
Pulmonary infarction may be complicated by the formation of abscesses. Being of
small sizes and small quantities they disappear within 7-10 days. Large abscesses do not
disappear themselves, they lead to the formation of fibrosis. Hemorrhagic pleurisy is often
considered to be the main complication. It is an inflammation of the pleura accompanied
by the formation of a blood clot in its cavity. The disease has severe clinical manifestations
and is treated for quite a long time. Also lungs hypostasis and their swelling are thought to
be possible complications. This complication is characterized by problems with breathing,
shortness of breath, pain in the chest and other symptoms that poses a threat to the life of
the patient.
DIET AS AN EXTERNAL FACTOR IN THE
PHENYLKETONURIA
Gubershtro Y., Triukhan V. - the 3rd year students
Scientific leaders – Doc.Biol.Sc. A.V. Krylov, O.I. Katina
PATHOGENESIS
OF
Classic Phenylketonuria (PKU) – is a rare hereditary disease associated with
impaired metabolism of amino acids. A person with phenylketonuria is not able to break
down the amino acid phenylalanine that comes from protein foods. As a result, compounds
poisoning the nervous system and the brain in particular accumulate in the tissues. Mental
retardation up to idiocy develops. In connection with this the illness received another name
- phenylpyruvic oligophrenia. However, among all the hereditary diseases phenylketonuria
is the only one that can be completely neutralized. Today a child born with symptoms of
PKU can grow perfectly healthy. To protect the baby's brain is possible using a special
diet. Due to this diet it is possible to cure the child during the first 2-3 years. Children with
PKU are born completely healthy. Therefore, if detect the disease during the first days of
life and keep to the diet, it is possible to prevent the destruction of the child's brain.
If the moment is missed, and the child eats protein foods rich in phenylalanine,
symptoms of lesion of the central nervous system appear. First the changes are insignificant
in patients with phenylketonuria. It's a weakness and anxiety. The kid never smiles and
moves a little, the child is poorly responsive, does not recognize the mother. Phenylalanine
and its derivatives are excreted in urine and sweat. They cause a specific musty smell. If
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phenylketonuria is untreated, the patient's condition will deteriorate. It is necessary to
exclude completely from the diet the animal proteins in order to get the nerve cells of the
child not to be exposed to toxic effects of phenylalanine and its derivatives. If this is done
in the first weeks of life, the brain will remain completely healthy. If you start to limit
protein at a later age, it is possible to pause the arrest of development. But to return a health
to the nervous system and to eradicate the changes in the nerve cells will fail. All necessary
for growth and development amino acids enter the body from specialized medical products.
Usually they are a powder, a dry mixture of amino acids, nutritional means, the peptides
(shaded enzymes milk proteins); free amino acids (tyrosine, tryptophan, cystine, histidine
and taurine). Children of patients with PKU can be breastfed. But nursing mothers need to
keep a special diet. In the diet of preschool and school-aged children protein foods are
completely excluded from the menu. In the list of allowed foods are vegetables, fruits. So
to build cells and growth of the body the child needs 120 mg of tyrosine per kilogram of
mass per day. Vitamins C, B6 and B1, folic acid, iron, calcium and magnesium are also
prescribed. The number of calories should be increased in 30% compared with the daily
norm of their contemporaries.
TREATMENT OF HEMOLYTIC DISEASE OF THE NEWBORN
Pernecky S., Pushkov A. – the 3rd year students
Scientific leaders - E.P.Ivanova, O.I. Katina
Early exchange blood transfusion is the most important means for the treatment of
hemolytic disease of the newborn. It should be made in the first 12-24 hours after birth.
This includes the timely diagnosis. With exchange blood transfusion hemolyzing
antibodies circulating in the bloodstream of the child, the destroyed red blood cells and
bilirubinemia are eliminated. Bilirubin is toxic. It prevents cell respiration and the synthesis
of phosphorus that is abundant in energy required for the process of respiration. At the
same time the child receives fresh red blood cells that are not affected by antibodies
remaining in the circulation and antibodies entering from the tissues. By introducing fresh
citrate blood the child's body and especially his brain is provided with oxygen.
Blood transfusion should be made with fresh citrate Rh-negative blood of the same
group, and, in exceptional cases, with conserved blood with the lapse of time no more than
3-4 days. Stored blood should not be transfused, as it increases the level of potassium.
There are some other changes in the balance of electrolytes that can lead to seizures or
states of tetanic hyperexcitability. It is better to transfuse heparinized blood as this avoids
hyperkalemia and hypocalcemia.
Exchange blood transfusion made in the first 24 hours reduces the mortality rate to
3.5%. Timely exchange transfusion helps greatly to prevent the severe brain damages.
After exchange transfusion reasonable hyperregenerative anemia without hemolysis signs
often appears. To fight against dehydration a child is prescribed enough fluids orally or
parenterally in the first days. Thus they prevent the formation of X-protein. At hemolytic
disease of the newborn Shaban recommends to inject 1-2 ml of liver extract with 3 ml of
5% dextrose daily. In addition, and 3 mg of vitamin K, 100-200 mg of vitamin C, 10 mg
of vitamin Bi- and 10-20 mcg of vitamin B12 are prescribed. The oxygen is of great
importance. After exchange blood transfusion the baby is placed in incubator or has
complete rest. On the first day the child is oftengiven 5% glucose with saline solution.
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VIOLATION OF PROTEIN METABOLISM AS THE CAUSE OF HEREDITARY
DISEASES
Pushkov, A., Park E. – the 3rd year students
Scientific leaders - Doc.Bio.Sc. A.V. Krylov, O.I. Katina
Violation of the metabolism of certain proteins-enzymes or structural proteins is the
basis of different hereditary diseases: hemoglobinase, albinism, phenylketonuria,
galactosemia, hemophilia, and many others. Violation of any of the enzymatic functions is
often associated with not only the lack of the corresponding protein - enzyme, but with the
formation of pathologically changed inactive product.
Determination of the activity of many enzymes in the blood, urine, cerebrospinal,
seminal and other body fluids is used for diagnosis of several diseases. With the help of
this analysis of the blood serum it is possible to detect myocardial infarction, viral hepatitis,
pancreatitis, nephritis and other diseases at an early stage.
Abnormalities in the structure of mRNA and tRNA mutations can cause the
formation of abnormal proteins. As a result inadequate amino acid affiliates to tRNA and
is included in the polypeptide chain during its adjustment (such as in the formation of
hemoglobin).
The absence, reduction or excess of activity of any enzyme in humans leads to
diseases or death of the organism. So, in the basis of phenylketonuria is the process of
turning the amino acid phenylalanine into tyrosine.
The process of translation is complex. Violation of the function of any enzyme may
lead to the process when one or the other of the mRNA does not transmit encoded
information.
It is very important to detect the disease at an early stage. Therefore, during the first
days of life there is a survey - screening of newborns. Most of the diseases associated with
the violation of the structure of amino acids or proteins can be successfully treated with a
specific diet. Due to this the child will grow healthy. For example, with the detection of
elevated levels of phenylalanine and other substances the cause is determined. If it is
phenylketonuria, the child is administered a treatment in the form of a special diet. Also it
is possible to use the replacement therapy aimed at changing of the metabolism. Special
sweep without phenylalanine are made for children.
PATHOMORPHISM OF DIC IN NEWBORNS
Krasilnikova V. – the 3rd year student
Scientific leaders – Doc.Med.Sc. I. Yu. Makarov, A.I. Petrakov, O.I. Katina
DIC (disseminated intravascular coagulation, consumption coagulopathy,
thrombohemorrhagic syndrome) — is an impaired blood clotting because of the massive
release of thromboplastic substances from tissues. For this pathology blood coagulation
with the formation of aggregates of blood cells and microclots, blocking blood circulation,
is characteristic.
Violation of hemostasis in the system mother-fetus occur more often when placental
abruption, amniotic fluid embolism, eclampsia and pre-eclampsia, induced abortion, fetal
death, intrauterine infection, molar, rupture of the uterus, prolonged childbirth different
etiology, transfusion insufficient blood, significant placental bleeding, etc.
There are predisposing factors contributing to the development of DIC in newborns:
the underdevelopment of the reticuloendothelial system, the lack of vascularization in the
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microcirculatory level, the lack of ability of liver compensatory synthesis of coagulation
factors of the blood of fibrogenesis, vitamin K-dependent factors, AT-III and plasminogen.
The morphological changes in DIC consist in the presence of fibrin thrombi and
emboli in blood vessels of various organs, especially in small arteries, veins and capillaries.
Blood clots are in the vessels of the brain, lung, kidney, placenta, and occasionally in the
blood vessels of the gastrointestinal tract, the thymus gland. The walls of small arteries are
exposed to mucoid swelling and fibrinoid change. Coagulation necrosis and desquamation
of endothelium occur. There may be the thrombosis of large vessels. For example, there is
often the thrombosis of the sinuses of the dura mater, thrombosis of the arterial duct
extending in the aorta, and thrombosis of renal veins.
DIC is a frequent and severe complication of various pathological processes of the
perinatal and neonatal periods. It is noted in 36-50% of all cases of perinatal death.
CRYING CAT SYNDROME
Krasilnikova V., Chernushevich D. - the 3rd year students
Scientific leaders – Doc.Biol.Sc. A.V. Krylov. O.I. Katina
The crying cat syndrome (purring) or Lejeune’s syndrome (cri du chat syndrome)
(1963) – is a rare genetic disorder provoked by the absence of a fragment of the 5th
chromosome. Karyotype 46 XX or XY, 5P- . The French pediatrician Jean Lejeune studied
the disease in details. Thus a newborn has an unusual cry, which is similar to meowing of
a cat. Lejeune’s syndrome – is a rare disease often occuring in girls. Any damaging factors
acting either on the reproductive cells of the parents, or to a fertilized egg during its
fragmentation and the formation of the zygote can cause a mutation that leads to the
development of the cri du chat syndrome.
Pregnancy with a child who has a crying cat syndrome may be completely normal.
The disease is diagnosed on the basis of the complex of characteristics and cytogenetic
studies. It is the "cat cry" that is a symptom characteristic only for the Lejeune’s syndrome.
It is heard in the first days of life, as the defect of the larynx was formed during the fetal
development. The cry has more high tones than in normal children. And, according to the
description of pediatricians and parents, it resembles the meowing of a hungry kitten.
The prognosis is usually unfavorable. But with an adequate education children can
learn to read and write, and perform simple tasks.
FOOT GANGRENE AS A COMPLICATION OF DIABETES
Rodionenko K., Askerova A. - the 3rd year students
Scientific leaders – Doc.Med.Sc. I.Y. Makarov, O.I. Katina
Diabetes is one of those pathologies against which a variety of complications and
secondary diseases often develop. Disappointing medical statistics shows that every second
patient attending endocrinologist for diabetes has a number of related problems in his
medical history.
One of the most difficult late complications in diabetes – is gangrene: local necrosis
due to deterioration of the peripheral circulation.
Causes of gangrene in diabetes and factors associated with the appearance of
gangrene in diabetes may be as follows:
- embolism due to atherosclerosis and ischemia;
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-
slow regeneration in diabetic patients. Due to this even small wounds become
infected that contributes to the development of infectious gangrene;
- polyneuropathy developing as a result of disruption of glucose metabolism (lose
the functionality of the microvessels of the nerve trunks, because of what cells
are affected to premature aging and necrosis);
- violation of bone formation process (this leads to osteoporosis and aseptic
necrosis);
- reduced immune status;
- the excess weight;
- tight uncomfortable shoes;
- smoking.
Typically, diabetic patients have reduced pain threshold. And they cannot notice the
appearance of ulcers and wounds, cracks, calluses on the body. Meanwhile, there are
pathological processes in the affected area - infection with pathogenic bacteria and fungi,
seizure of larger area of tissue. Sensitivity loss is due to chronically elevated levels of sugar.
It leads to poisoning of the organism and death of nerve endings that transmit pain signals
and control sensitivity.
Nerves responsible for sweating also perish. That leads to constant dryness of the
skin, the appearance of cracks and promotes active proliferation of pathogenic organisms.
If left untreated due to complications on internal organs, gangrene is fatal. But
sometimes even the timely reference to the doctor does not help to save the dead tissue. In
uncared cases there is only one method of radical treatment of gangrene - amputation of
the affected limb. Relatively successful clinical situations are those when at diabetic
gangrene surgeons have to amputate only a finger phalanx. Sometimes amputation of the
affected foot is exposed to the knee or higher.
When gangrene the lower limbs are mostly affected, rarely other areas of the body
- arms or trunk are affected.
EUTHANASIA - PROS AND CONS
Makarova A., Yaroslavtseva A. - the 3rd year students
Scientific leaders – V.V Grebenyuk, O.I. Katina
Euthanasia is the practice of termination of human life, suffering from an incurable
disease and experiencing unbearable sufferings.
In Russia euthanasia is prohibited and is qualified as murder.
Where is euthanasia officially authorized? There are four places where this
resolution operates - Nederland, two parts of America, and the Northern Territory of
Australia. Only in Northern Territory euthanasia is officially permitted by law, Oregon
(statute) and the two parts of the United States (decisions of the Appeal Courts of the
Second Circuit (New York, etc.) and the Ninth Circuit (California, Oregon, and others.)
ousting prohibitions established by law), a doctor may prescribe the drugs causing the death
to the patient, but he is not allowed to give them by himself. In the Netherlands, physicianassisted suicide and active (voluntary) euthanasia is prohibited by statute, but allowed in
practice. According to the Court, the doctor euthanatized (or contributed to suicide) his
patients in certain circumstances is admitted to be not guilty. These laws and policies set
three conditions:
1) euthanasia must be voluntary,
2) only a doctor can provide assistance or carry out euthanasia,
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3) state of the patient should be medically unsatisfactory.
Among the students of the Amur State Medical Academy a questioning aimed to
reveal the attitude of medical students to euthanasia was conducted. They were asked to
answer three questions:
- What is your attitude towards euthanasia?
- Would you be able to carry out euthanasia legally?
- Is it advisable to permit euthanasia in our country?
On the first question 41% of respondents answered positively and 59% are opposed
to euthanasia.
On the second question 37% of respondents answered “yes”, explaining it this way:
"with the consent of the patient; if the situation is hopeless, to eliminate the suffering of a
patient". 63% replied negatively, explaining it as follows: "No, because we are doctors and
must heal, but not kill; no one has the right to decide whether to live or die; because it is a
murder; because of religious beliefs".
On the third question 4% of the students agreed that euthanasia should be permitted
in our country. And 96% answered against allowing euthanasia, explaining it by the fact
that our country is not ready for this.
On the basis of the study it can be concluded that the majority is against euthanasia
and consider it to be unacceptable. The essence of euthanasia contradicts to the Hippocratic
Oath: "I will not let anybody a deadly drug if asked me and will not show the way for such
a plan".
ISCHEMIA
Hertek S. – the 3rd year student
Scientific leaders – M. E. Ostykova, O. I. Katina
Ischemia is an imbalance between the inflow of arterial blood to the tissues and
organs and the need for it. The need in blood supply is always higher than the actual flow
of blood through the arteries. The cause of ischemia may be: compression of blood vessels,
narrowing or occlusion of the lumen from inside, the action of vasoconstrictor biologically
active substances as well as the influence of chemicals able to cause the contraction of
arterial smooth muscles and narrowing of the artery.
Clinical signs of ischemia are the decrease in the number and diameter of visible
blood vessels and decrease of their blood quantity, blanching of organ tissue due to
decreased volume of arterial blood, decreased pulsations power of blood vessels, reduction
of lymph formation, decreased volume of an organ, changing in the diameter of
microcirculatory vessels.
Consequences of ischemia are hypoxia and excess in the tissues of the products of
disturbed metabolism, ions, biologically active substances formed during ischemia.
Ischemia of such organs as the brain, heart, kidneys can lead to the death of the organism.
COMPARATIVE STATISTICS OF THE INTERNET USE BY SCHOLARS IN
THE AMUR REGION AND THE JEWISH AUTONOMOUS REGION
Salomatova E., Trofim V. - the 5th year students
Scientific leaders – Doc.Med.Sc. L.N. Voight, O.I. Katina
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Internet addiction disorder is often called the problematic Internet use (PIU). It is
determined as excessive computer use that interferes with daily life.
Problematic Internet use is also called compulsive Internet use (CIU),
or pathological computer use, or Internet addiction disorder.
Epidemiology
Over the past decade, the concept of Internet addiction has increased in terms of its
affiliation as a legitimate clinical disorder that often requires treatment. Researchers argue
over whether Internet addiction is a substantive disorder or a symptom of another
underlying disorder. There is also debate over whether it should be classified as
an impulse-control disorder or an obsessive-compulsive disorder rather than an addiction.
While the existence of Internet addiction is debated, self-proclaimed sufferers use
the courts for compensation.
About 25% of users have criteria of Internet addiction within the first six months of
using the Internet. Many individuals initially report of being psyched by the computer but
gradually they feel a sense of "competency and exhilaration from mastering the technology
and desire to learn quick navigation between the applications by visual stimulation".
Public concern, interest and the study with the use of Internet may be due to the fact
that it has become increasingly difficult to distinguish between the online and offline
worlds. The Internet has tremendous potential to affect the emotions of humans and so to
alter our self-perception and anxiety levels.
According to Maressa Orzack, director of the Computer Addiction Study at Harvard
University's McLean Hospital, between 5% and 10% of Web surfers have some form of
Web addiction.
According to the Center for Internet Addiction Recovery, "Internet addicts suffer
from emotional problems such as depression and anxiety-related disorders and often use
the fantasy world of the Internet to psychologically escape unpleasant feelings or stressful
situations". More than half of them are also addicted to alcohol, drugs, tobacco, or sex.
Scientists have found that compulsive Internet use can produce morphological
changes in the structure of the brain.
DIET IN HOT CLIMATES
Azadov S., Makarovа А. – the 3rd year students
Scientific leaders - N.V. Korshunova, O.I. Katina
Lack of knowledge about the mechanisms of adaptation and acclimatization in
regions with hot climates may be hazardous for the health, especially for those who visit
tropics and subtropics. At low latitudes the formation of as specific diseases - heat losses
so as an increase in the number of cases occurring in all climate zones is possible.
Particularly these are neuropsychiatric disorders, diseases of the skin, trauma, urolithiasis,
ARVI, diseases of the cardiovascular system, especially in persons over 45 years.
Rational diet takes an important place in the complex of measures for adapting to
the heat.
Food: diet should take into account the peculiarities of the action of heat on the
human body. In hot climates the body has to release heat to ensure thermal balance.
Therefore, the basal metabolic rate is reduced as by the decrease of caloric intake so as by
the decrease of heat production.
While thinking of a diet in a hot climate one should especially consider the
metabolism of protein and minerals. If you are in the desert or semi-desert, first of all
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protect yourself from UV rays by all possible means. They affect the metabolism and may
become a cause of poor work of digestive glands and reduce the acidity of gastric juice. If
you are intended to get rid of extra kilos, remember that in the summer it is more easily to
lose weight.
Ration in hot climates should contain the optimum amount of proteins, water
soluble vitamins and minerals, and less saturated fat. At the same time, in hot climates, try
to reduce protein intake, otherwise it will lead to excessive heat load and increase thirst.
Conversely carbohydrate intake is considered to be useful as they reduce the need
for protein, the body overheats slowly, and due to reduction of urination the organism will
lose less moisture. It is also important to increase endurance. It can be done with the help
of special tools and drugs.
But the fact that high temperatures reduce appetite is not secret. Delicious food,
spices and various hot dishes and snacks, green tea half an hour before the main meal will
help you to increase appetite. Also remember that it is advisable to keep strictly to the diet
and eat at a certain time.
REGENERATION. ITS IMPORTANCE FOR THE ORGANISM
Oorzhak Ch., Damchat A., Kungaa A. – the 3rd year students
Scientific leaders – S.S. Perfilieva, O.I. Katina
The report is devoted to the study of general information about the regenerative
processes, its types and mechanisms of occurrence in different levels of the organization,
violations of regeneration progress.
It should be noted that the regeneration is the ability of living organisms eventually
repair the damaged tissues and organs. It is of two kinds: physiological and reparative.
The report describes in detail as the physiological regeneration due to which it is
always possible for a body to perform various functions and reparative regeneration
responsible for the recovery of organs and tissues destroyed during injury or pathological
changes.
The main aim of the work is to reveal the processes of regeneration at all levels of
organization of living matter: molecular, subcellular, cellular, tissue and organ levels.
The study of regeneration is very important in our time. Knowledge of regulation
mechanisms of the regenerative ability of organs and tissues gives the prospects for the
development of scientific bases of stimulation and control over the recovery processes.
CHILDREN'S HEALTH GROUPS
Barabash A. – 3rd year student
Scientific leaders – Prof. N.V. Korshynova, O.I. Katina
Every day the hospital admits a large number of children. In order to assess human
health adequately, to provide him with necessary medical care and optimal range of
medical services health groups were developed. Their criteria take into account the state of
health of the younger population. Health groups represent a scale that is used in
determining the state of the body and the development of a growing person. Each item of
this scale also counts the risk factors that affect or influence the condition. In accordance
with this scale a preliminary forecast for the future is done. But the health group given by
a local pediatrician may be changed in a time.
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CARDIAL LIVER CIRRHOSIS
Lytsuk V., Barabash A. – the 3rd year students
Scientific leaders – Doc.Med.Sc. I.Y. Makarov, A.I. Patrakov, O.I. Katina
Liver cirrhosis is a chronic disease accompanied by irreversible replacement of the
parenchymal tissue of the liver by fibrous connective tissue or stroma. One of the secondary
liver cirrhosis is cardial one. Etiological factor in the development of this type was not a
primary liver pathology but the diseases of another organ – in this case the hearts. Heart
failure in its last stages leads to liver cirrhosis. They distinguish left and right ventricular
failures of the heart. Whereby, the stagnation in the systemic circulation develops. In the
result of it there is the development of this disease. It is difficult to identify the signs of
cardiac cirrhosis at an early stage. It is almost impossible to establish the cause of cirrhosis
by the symptoms. This type of cirrhosis is characterized with the same signs as other types.
Macroscopically the liver is enlarged, dense, its edges are rounded, and the cut surface is
mottled, gray-yellow. Microscopically there is a remarkable increase of periportal areas
with fibrosis around the proliferating cholangioma, intralobular fibrosis around
intralobular cholangioma with dissociation of the liver cells. Mainly in cardiac cirrhosis
the outcome is not favorable. In most cases the period of life of the patient is no more than
3 years.
PATHOPHYSIOLOGY OF STRESS
Kolesov B., Volodina I. – the 3rd year students
Scientific leaders – Doc.Biol.Sc. N.A. Ishutina, O.I. Katina
Stress is a set of protective and damaging body reactions appearing due to
neuroendocrinal and metabolic changes in response to the emergency or pathological
factors manifested in the adaptation syndrome.
Factors causing stress reactions are called stressors. They vary in the strength,
duration and specificity. But their primary role in vivo is to mobilize non-specific
biological response, i.e. stress.
Stress arises not only under the influence of strong or extraordinary stimuli, but also
weak, long and recurrent.
When stress, the sympathetic-adrenal system is initially activated resulting in an
increase of catecholamines (adrenaline and noradrenaline) in blood levels .They provide a
rapid transition of an organism from a calm state into a state of excitement, often of quite
prolonged duration.
At present stress is established to be accompanied with functional (neuroendocrine,
metabolic) and morphological changes. The role of stress as the main etiological factor of
ulcerative lesions of the gastric mucosa, hypertension, atherosclerosis, disorders of
structure and function of the heart, formation of immunodeficiency states and malignant
tumors, metabolic disorders was proved.
Tranquilizers are widely used in stress situations and their prevention.
Benzodiazepines and anti-oxidants, the food antioxidant ionol, and vitamin E inhibit the
lipid peroxidation so characteristic for stress.
HYGIENE OF WORK OF HEALTH PROFESSIONALS
Yaroslavtseva A., Volodina I., Kolesov B. – the 3rd year students
Scientific leaders – Cand.Med.Sc. D. A. Semenov, O. I. Katina
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The work of doctors has its specificity as daily and night duties, absence of fixed
lunch breaks, busiest working day, violation of working, resting and feeding regimens.
The professional activities of doctors are indicated with great nervous and emotional
stress associated with the responsibility for the life of the patient and the need to take
immediate important decisions for the life of patients.
But there are new hazardous factors for doctors: ionizing, laser and ultraviolet
radiation, ultrasound and ultra-high-frequency fields, high and low atmospheric pressure,
as well as the impact of aerosol antibiotics, anesthetics and other drugs.
Each specialty has its professional diseases. But there are some common disorders
which degree varies slightly with the specialty.
The leader on the detection is viral infections that can be caught anywhere. Second
place among the professional disorders of medical staff is for allergic diseases. The third
place among the professional disease of doctors is divided between intoxication and
diseases of the musculoskeletal system.
The main prevention areas: optimization of work and rest (especially the staff of
health facilities of hospitals, surgical nurses), creating of optimal microclimate conditions,
prevention of air pollution, radiation safety. When the occupational disease risk, a health
worker should change a specialty.
GANGRENE
Makarova E., Volodina I., Kolesov B. – the 3rd year students
Scientific leaders – S.S Perfilieva , O.I. Katina
Gangrene is tissue necrosis contacting with the external environment. The tissue
becomes gray-brown or black. It is associated with the conversion of blood pigments into
iron sulfide. There are dry and wet gangrene.
When dry gangrene the dead tissue exposed to air becomes dry, consolidate crimple.
It reminds a mummy cloth. Therefore dry gangrene is also called mummification. Dry
gangrene occurs in tissues poor with moisture. For example: dry gangrene of the limbs in
atherosclerosis and thrombosis of its arteries (atherosclerotic gangrene), with frostbite or
burns, dry gangrene of fingers in Raynaud's disease or vibration disease, skin - in infections
(typhus) accompanied by profound disturbances of trophicity.
In wet gangrene the dead tissue is exposed to putrid mcroorganisms (Вас.
perfringens, fusiformis, putrificans, histolyticus, proteus.). It swells, becomes edematous
and emits a fetid odor. Wet gangrene usually develops in the tissues that are rich in
moisture. Its emergence is stimulated by blood circulation disorders (venous stasis) and
lymph (lymphostasis, swelling). Wet gangrene occurs in the lungs worsening the
inflammatory proesses (pneumonia), in the gut with obstruction of mesenteric arteries
(thrombosis, embolism). In children suppressed by infectious disease (usually measles) wet
gangrene of the soft tissues of the cheeks, the perineum may develop. It is called noma
(from the Greek nome – water cancer).
Anaerobic gangrene should be distinguished from the dry and wet gangrene. It is an
independent infectious disease caused by a group of certain microorganisms (especially
Bac. perfringens). It often occurs with gunshot and other wounds accompanied by massive
destruction of muscles and crushing of bones.
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Bedsores are defined as a kind of gangrene - necrosis of the superficial areas of the
body (skin, soft tissue) exposed to pressure. Therefore, bedsores usually appear in the area
of sacrum, spinous processes of the vertebrae, the greater trochanter of the femur.
PHENYLKETONURIA
Yusupova N., Shishmaref V. – the 3rd year students
Scientific leaders – Cand.Med.Sc. N.N. Dorofienko, O. I.Katina
Phenylketonuria (PKU) is a serious hereditary disease occurring due to a congenital
defect of the enzyme responsible for the normal metabolism of phenylalanine
(phenylalanine is one of essential amino acids included in the protein). The disease is
inherited in an autosomal recessive type.
The etiology and pathogenesis. As a result of mutations of the gene controlling the
synthesis of phenylalaninehydroxylase, the metabolic block at the stage of conversion of
phenylalanine into tyrosine develops. So the basic way of phenylalanine conversion
becomes deamination and the synthesis of toxic derivatives - phenylpyruvic, phenyl-lactic
and phenylacetic acids. The content of phenylalanine significantly increases in the blood
and tissues (0.2 g/l or more at the rate of 0.01-0.02 g/l). A significant role in the
pathogenesis of the disease is insufficient synthesis of tyrosine that is a progenitor of
catecholamines and melanin.
Treatment. The main method of treatment is diet restricting the intake of
phenylalanine; it must be kept immediately after diagnosis. With early diagnosis it
guarantees the normal psychological development of a child. Keeping to the diet in the
later stage will not return a normal intellect to a child. If this disease is diagnosed on mental
retardation but not immediately at birth, it cannot be cured.
Prevention of phenylketonuria:
1. The detection of heterozygous carriers. The special supervision of families at risk
is of great importance, i.e. such families where there were already children with
phenylketonuria. Newborns of these families should be subjected to mandatory
biochemical studies and the indications for early treatment.
2. The introduction of mass screening of newborns for early detection of
phenylketonuria and the timely administration of the diet. The identification and treatment
of children in mass screening also allows to prevent the development of severe mental
disability.
3. Prenatal diagnosis: the DNA-probe for prenatal diagnosis of PKU in families at
high risk is proposed.
Phenylketonuria is a serious genetic disease that is not common in our country, but
sometimes it still occurs. So, with the early detection of disease and proper diet the child
with PKU can grow perfectly healthy.
CONSEQUENCES OF FLOOD IN THE FAR EAST IN 2016
Bryunina S., Bugera R. – the 2nd year students
Scientific leaders – Cand.Biol.Sc. L.A.Guba, O.I.Katina
The flood lasted from July to August.
In Selemdzinski district 48 areas were flooded. It resulted in river spill.
In Birobidzhan the cause of flooding was a fast uprise of water level in the Tom
River due to the displacement of the peak of the rain flood. 47 areas were flooded.
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After abundant rainfalls the level of the Bira River began to increase being the cause
of flooding in Belogorsk region. Here 53 areas were flooded.
As a result, Belogorsky region suffered the most.
TREATMENT OF BREAST CANCER CONSIDERING RECEPTOR FIELD OF
TUMOR AND HORMONAL RECEPTION
Prokofyeva N. – the 3rd year student
Scientific leaders – T.N. Korobkova, O.I. Katina
The incidence of breast cancer is characterized by a tendency to steady increase.
Since the end of the last century, the disease is among the leading cancer pathology in
women. Each year about 1.5 million new cases of the disease are diagnosed. Breast Cancer
- is a heterogeneous group of malignancies. Depending on the type of cancer, its size,
location, growth characteristics, presence of metastases, and some other parameters the
tactics of treatment and prognosis of the disease will vary. One of the manifestations,
indicating the breast cancer, is the type of expressed (presented on the cell surface) specific
receptors of tumor.
The main receptors in the membrane of breast tumor cells include: estrogen
receptor, progesterone receptor and receptor of epidermal growth factor (EGFR) with its
HER2 tyrosine protein kinase family of epidermal growth factor receptor.
According to the type of hormone receptor on the surface of tumor cells 2 types of
breast cancer are defined: hormone-dependent and hormone-independent. About 75% of
all breast cancers are hormone-positive. This means that there are receptors on the
membrane of tumor cells. And they can connect with the receptors of the female sex
hormones. Hormones play an important role in the regulation of normal growth and
development of breast cancer, as well as its tissue homeostasis. However, the role of
hormones is twofold. The stimulating effect of hormones on the growth of malignant
tumors was revealed.
The last two decades have led to a breakthrough in the treatment of breast cancer preparations of punctuate affection on the modified cancer cells are included in clinical
practice. They are called "targeted" - or drugs of target. They affect the molecular structures
- external and intracellular receptors, proteins produced by tumor cells and blood vessels
growing around the tumor. These are the "targets" of functioning of tumor cells. And their
defeat leads to the death of the latter. Since 1990 about 15 targeted therapies have been
registered.
Hormone therapy in breast cancer aims to deny the possibility of hormones to
influence the cells. Drugs of one of the three major schemes of hormone therapy are used.
They differ in mechanisms of action:
1) reduction of estrogen levels in blood by reducing the functioning of the organs
that produce it (ex. ovarian) or inhibiting the production of estrogen by using an aromatase
inhibitor (Femara, Arimidex, Aromasin);
2) blocking the estrogen receptors (tamoxifen);
3) the destruction of estrogen receptors (faslodex).
Hormone therapy can increase the effectiveness of other cancer treatments (surgery,
radiation therapy, and chemotherapy) reducing the risk of relapse. At present hormone
therapy is not used as independent method of treatment.
HER2 receptors – are protein molecules located on the cell surface. Normally due
to them the body controls the process of growth, division and recombinational repair of
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healthy breast cells. Approximately 25% of patients with breast cancer have an increased
content of similar receptors. As a result the cell receives commands to increased cell
division and begins to grow and multiply in an uncontrolled manner. This cancer is called
HER2-positive and is characterized by an aggressive course, early metastasis, resistance to
chemotherapy and hormone therapy. The drug called Trastuzumab (also known as
Herceptin) was developed for the treatment of HER2-positive breast cancer. It is a kind of
monoclonal antibody. Herceptin attaches to the HER2 protein and prevents human
epidermal growth factor to achieve breast cancer cells and stimulate their growth.
Herceptin is only effective if a person has a high level of HER2 protein. At present targeted
therapy is the most promising direction in oncology. As with its use it is possible to realize
an impact on determining mechanisms of tumor development minimizing the damage of
healthy tissue. In the world a number of new targeted therapies for the treatment of breast
cancer were developed. They include lapatinib, pertuzumab, T-DM1, neratinib, afatinib.
NEUROCYSTICERCOSIS
Aniskova Y. – the 5th year student
Scientific leaders – T. A. Dolgykh, O.I.Katina
Cysticercosis is biohelminthosis caused by parasitizing with larval stage of
T.Solium- cysticercus inside human’s tissues and organs. The infection is a result of
autosuperinvasion or catching the parasite’s eggs. Brain cysticercosis is widely spread in
the Southern and the Central America, the Africa, India, China, Ukraine, Belorussia,
Georgia, Siberia. As for the Western Hemisphere, it is spread from Mexico to Chili. For
example, in Mexico about 10 % of hospitalizations and above 25 % of skull trepanation
are based on this disease.
Clinical manifestations of this helminthosis are quite diverse. They depend on
localization, quantity and development stage of the parasite. Personal responsiveness of
human organism also matters.
41-82 % of accidents are the result of cysticersus being inside the brain. When the
parasites are located in large brain hemispheres arachnoidite takes place. The affliction
starts with sudden consequently increasing accesses of high ICP with light intervals which
can last for months and years. These accesses are accompanied with headache, emesis,
convulsions, paralytic strokes, paresis, Jacksonian’s epileptic seizures. Also there can be
periodic psychiatric disorders as delirium and hallucinations. Eventually the infected
person gets mental problems and loop of intellect. Basal brain surface syndrome has the
same symptoms as arachnoidite does. The last one spreads over cranial nerves, cerebral
peduncles, bottom of the III cerebral ventricle. Liquor drainage breaks down and
hydrocephaly begins. Sometimes it causes additional cerebellar problems. Located in the
IV cerebral ventricle cysticercosis is shown by a hypertensive syndrome. There signs of
damaging V, VI, VIII craniocereberal nerves appear. Breath violations are frequent.
Sudden death is possible.
The diagnosis is determined on the basis of the anamnestic, clinical, epidemiological
and laboratory data. And it is confirmed with instrumental and immunological researches.
To identify cerebral lesions CT and MRT, angiography, ultrasonic investigation of brain
are used. In the cerebrospinal fluid there is pleocytosis with prevalence of eosinophils and
lymphocytes, increased protein level. Later when calcifying the cysticercus, they can be
detected by means of a radiological exploring of cranial bones.
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Indications for removing the parasite with trepanation occur when cysticercus settles
inside cerebral ventricles and may cause peracute obstruction of liquor canals. In case of
localization in other departments of the brain antihelminthal therapy is used. As indications
for surgical intervention are less due to dissemination of the process and intensity of
inflammatory changes.
Considering serious course of this disease, the adverse forecast, need of lifelong
observation and treatment of patients, it is required to pay much attention to developing of
nonspecific methods of prophylaxis and new ways of maintaining patients with a
neurocysticercosis.
SODOKU
Fedotov S. – the 5th year student
Scientific leaders – Т.А.Dolgikh, O.I.Katina
Sodoku - is a zoonotic disease from the group of wound infections caused by
spirillae and characterized by recurrent fever, lymphadenopathy, and rash.
The first descriptions of the disease associated with the bite of rats appeared in Japan
for more than two thousand years ago (so – “rat”, doku – “poison”). The cases of infection
were registered in the US, Western Europe, Australia and Africa. But the highest
infestation of rats is in East Asia. The disease can lead to serious consequences such as
affections of the CNS (paresis, paralysis, mental disorders), the heart (myocarditis,
endocarditis, pericarditis), the respiratory system (spirillizion bronchopneumonia), kidneys
(nephritis).
The causative agent of this disease is Spirillum minus, kind Aquaspirillum.
The main source of infection is the rats. Spirillums are the saprophytic inhabitants
of the oral cavity of a rat and they are detected in the blood and viscera. Also, the other
sources of infection are rodents, dogs and cats. The infection can be transmitted from the
one animal to another through bites, eating spoils of animals died from sodoku, through
milk and transplacental. A sick person is not contagious, but the infection of the recipient
is possible by the transfusion of infected blood. Human susceptibility to sodoku is high.
Most often the sporadically cases occur among hunters, plumbers, slaughterhouse
employees.
The incubation period – is from 3 days up to 2 months. The disease begins acutely
with increasing the body temperature to 39-40 ° C, chills, headache, joint and muscle pain.
At the site of the bite there is a hyperemia area with the painful seal in the center (primary
affect). Then in its place a vesicle appears resulting in a deep ulcer with pitted edges. It
cicatrizes in a few days. There is a regional lymphadenitis and lymphangitis. Febrile
seizure lasts 4-7 days. At 5-7 day a critical drop of temperature is marked being
accompanied by a collapse. Another attack takes place as the previous one, but with the
absence of the ulcer. On the background of fever rash appears first on the site of the bite
and then it spreads as throughout the body, so as one-sided, in the form of a “sleeve”, “halftrousers”, “jacket”. Polymorphism of rashes is characteristic. Totally from 5 to 20 febrile
episodes separated by apyrexia periods are noted. Such a long course of the disease
exhausts patients. Against this background cachexia is registered. Also the joining of
bacterial infections and death is possible. Severe course is characterized by intoxication
syndrome, as well as the possible development of multiple organ failure.
Pathogen is found in the blood under phase contrast microscopy or in the dark field.
A thick drop of blood is analyzed. Serological methods – are the reaction of spirillae lysis
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with the serum of patient’s blood, RA, RW. Biological samples are also used on white mice
or guinea pigs.
The penicillins, cephalosporins III generation, carbapenems, tetracyclines are used
as a causal therapy. Prognosis is mostly favorable.
Thus, considering the diversity of clinical forms of sodoku, it is necessary to pay
attention to the differential diagnosis with other infectious diseases. The paramount
importance at diagnosis should be given to the collection of epidemiological anamnesis.
FASCIA OF LOWER LIMBS AND THE SPREAD OF PYOGENIC INFECTIONS
Lobanova N., Grichanovskaya K. - the 2nd year students
Scientific leaders – Cand.Med.Sc. S.S.Seliverstov, O.I.Katina
Fascia – are membranes of fibrous connective tissue covering the muscles, blood
vessels, nerves, some internal organs and forming them fascial bed, vagina, and lining
cellular spaces. In the lower limb the following fascia are identified: gluteal, iliac, wider,
shin fascia and the fascia of the foot.
Purulent infection – is an inflammatory process of various localization and nature.
It takes one of the main places in the surgical clinic and makes the essence of many diseases
and postoperative complications. A third of all surgical patients have purulentinflammatory diseases.
A number of fasciae promote or prevent the spread of purulent processes. Fasciae
of muscles counteract the spread of pus or blood, and fasciae of neurovascular bundles
contribute to the spread of pus from one area to another. Fasciae are involved in the
formation of anatomical channels both in normal and pathological conditions.
The doctrine of the fasciae and cellular spaces is important for understanding the
dynamics of the spread of purulent processes and foundation for the selection of rational
sections for draining abscesses. These processes are developed and distributed in the
subcutaneous and intramuscular fat, in the course of vaginas neurovascular bundles,
through fascial and interfascial fissurae.
Purulent processes in the lower limbs extend in a downward direction and are
typically more severe. There are a large number of cellular spaces, cracks and anatomical
channels in the buttocks and on a thigh. They contain important neurovascular structures
that communicate with the cellular spaces of adjacent areas. In femoral hernia a channel
leading from the abdomen to the front of the thigh is formed.
With a contact distributing of pus purulent streaks, periodontitis, osteomyelitis,
septic arthritis, abscesses and phlegmon may develop. The most severe complication of
septic wounds is sepsis.
SKIN AS AN ORHAN OF HUMAN IMMUNE SYSTEM
Grichanovskaya K. - the 2nd year student
Scientific leaders - V.S. Kozlova. O.I. Katina
The skin is the largest holistic multifunctional organ directly containgct with the
external environment. It consists of epidermis (the epithelial tissue) and dermis (the
connecting base).
Epidermis is the external part of the skin. It is represented by stratified squamous
keratinizing epithelium. Its thickness varies from 0.05 mm on the eyelids to 1.5 mm on the
palms. About 95% of the epidermal cells are keratinocytes (derived from ectoderm). while
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cytodifferentiation they edge from basal membrane towards the skin. It consists of five
layers:
- the basal layer formed by keratinocytes, melanocytes, Merkel cells, Langerhans
cells and cambial cells;
- prickly layer comprising keratinocytes and Langerhans cells;
- granular layer consisting of 3-4 layers of oval shaped keratinocytes where
proteins keratin, filaggrin, involucrin and keratolinin are synthesized;
- lucid layer formed by flat keratinocytes;
- horny layer consisting of horny scales.
The dermis is divided into two layers - the papillary and reticular.
As an immune organ the skin is capable of isolation, pressure, presentation of
antigens and the development of local immune response. The skin contains
immunocompetent cells of bone marrow origin, such as resident histiocytes, mast cells,
Langerhans cells, lymphocytes and granulocytes.
Langerhans cells induce antigen-specific T-cell activation and promote the
generation of cytotoxic T-lymphocytes (CTL). Due to the antigen-presenting ability these
cells play a decisive role in the contact sensitization and immune defense against viruses.
T-cells make up 90% of all skin lymphocytes and are located primarily in the upper
layers of the epidermis and dermis. A small part of B-lymphocytes is found in the medium
and the deep dermis. A small number of antigen-specific T-lymphocytes are believed to be
in the same areas of former sensitization for a long period being the substrate of specific
immunological memory.
During inflammation keratinocytes begin to express antigens HLA - DR and
produce cytokines promoting the development and modulation of immune and
inflammatory responses.
The skin is often affected in primary and secondary immunodeficiency. At the same
time, the immunological structures of the skin allow it to carry out some of the pathological
processes independently.
There is an expressed antigenic stimulation of the skin as the barrier organ. Other
endogenous and exogenous factors can cause damages of one or several parts of the
immune system of the skin. It results in many immunopathological manifestations. All
types of immunopathological reactions can be implemented in the skin. That can be
observed in a number of various dermatoses.
ENZYMES MARKERS OF MYOCARDIAL INFARCTION
Dudnik M., Grichanovskaya K. - the 2nd year students
Scientific leaders - E.V. Egorshina, O.I.Katina
Myocardial infarction is ischemic necrosis of the area of cardiac muscle appearing
due to balance disturbance between the myocardium need of oxygen and its delivery
through coronary vessels. The main reason for increasing the activity of enzymes in the
serum content in patients with acute myocardial infarction is the destruction of
cardiomyocytes and passage of free cellular enzymes into the blood.
On admission of a patient to a hospital after manifestations of clinical signs of
myocardial infarction it is necessary to determine the activity of some enzymes: creatine
kinase (KK) and its isoenzyme (KK-MB), lactate dehydrogenase (LDG) and its
isoenzymes (LDG1-2), aspartatetransaminase (ASAT), and also cardiospecific markers
(troponin of T and I).
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At infarct development the increase of KK activity in the blood is noted usually in
6-8 hours after an attack. By the end of the first days the enzyme level exceeds the norm
in 3-20 times. In 3-4 days after the onset of a disease it returns to reference values. The
increase of KK activity in the blood is determined almost at all patients with myocardial
infarction.
Lactate dehydrogenase (LDG) – is a cytosolic protein with five isoenzymes.
Because of late concentration increase in the blood serum the LDG marker isn't used at
early diagnostics of a myocardial infarction. Rising of the general activity of LDG at a
myocardial infarction is caused by augmentation of activity of its isoenzyme - LDG 1.
The diagnostic criterion is not only an increase in the activity of isozymes but also
a change of relation of LDG1 / LDG2. In patients with myocardial infarction it is 0.76 or
above at normal rate of 0.45-0.74. The sensitivity of this index as a diagnostic of
myocardial infarction test is 40-95% and specificity - 85%.
Aspartate aminotransferase (AST) - is contained in large amounts in the liver and
has a low specificity for myocardial necrosis. For the diagnosis it is used in combination
with the sensitivity and specificity markers. Normally, the blood concentration of ACAT
in women is less than 31 U / l, in men - less than 37 U /L.
Troponin complex, found in the composition of the thin filaments in muscle
contractile apparatus, consists of three protein subunits: troponin I, troponin T and troponin
C. The concentration of cardiac troponin I in the blood used in the diagnosis of myocardial
infarction increases in 4-8 hours after the cardiac muscle damage. And it remains high for
several days.
KIDNEY ENDOCRINE APPARATUS
Zhorov N. – the 2nd year student
Scientific leaders – Cand.Med.Sc. D.A. Semenov, O.I.Katina
Endocrine kidney apparatus is a differentiated cell complex, located in the vascular
pole of the glomerulus between the afferent and efferent glomerular arterioles with closely
adjoining departments of the distal tubule.
Kidney endocrine apparatus includes juxtaglomerular apparatus (JGA) releasing
renin and erythropoietin, interstitial cells (IC) of medulla producing prostaglandins, as well
as the external layer of JGA capsule. There are four components in this apparatus: granular
epithelioid cells (juxtaglomerular cell); thick spot cells; Goormaghtigt cells; mesangial
glomerular cells.
Juxtaglomerular cells are located beneath the endothelium in the wall of the afferent
and to a lesser extent – efferent arterioles. They are oval and contain in the cytoplasm renin
granules, isolating them into the blood. Renin contributes to the increase of blood pressure
catalyzing the formation of angiotensin that has vasoconstrictor action.
Thick spot – is a wall portion of the distal area of nephron that is at the renal
corpuscle between the afferent and efferent arterioles.
Juxtavascular cells (Goormaghtigt cells) are located in the area of vascular pole of
renal corpuscles, in the triangular space between the afferent and efferent arterioles and
thick spot. Goormaghtigt cells are a kind of mesangiocytes - the so-called extraglomerular
mesangia. Mesangiocytes have contractile microfilaments and receptors for
vasoconstrictor substances. Juxtavascular cells and mesangiocytes begin to produce renin
at exhaustion of juxtaglomerular cells. But besides renin juxtaglomerular apparatus of the
kidney produces erythropoietin - erythropoiesis stimulating factor.
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Kallikrein-kinin system of kidneys is presented by nephrocytes distal tubules, which
produce the enzyme kallikrein. After the secretion into the lumen of the distal tubule it
interacts with kininogenom resulting in the formation of biologically active compounds kinins. As prostaglandins kinins have pronounced vasodilative properties.
FORM OF A CHEST AT THE AGE FROM 16 TO 25 YEARS
Bugera R., Brunina S. – the 2nd year students
Scientific leaders – Cand.Med.Sc. S.S.Seliverstov, O.I.Katina
Depending on the constitutional type there are normosthenic, asthenic and
hypersthenic forms of the chest in healthy people.
Normosthenic (conical) chest resembles a truncated cone with the base facing
upward. Epigastric angle (between the costal arches) is 90°. Scapulae contour unsharply.
Asthenic thorax is flat, narrow, elongated (anterior-posterior and lateral sizes are
reduced). Epigastric angle is less than 90°. The shoulders are lowered, the muscles of the
shoulder girdle are underdeveloped, and scapulae are decline from the back.
Hypersthenic chest wide and resembles a cylinder. Epigastric angle is oblique,
scapulae closely adjoin the chest. Its musculature is well developed. Epigastric angle is
more than 90°.
MENINGOCOCCAL DISEASE
Zhumikova Ju. - the 5th year student
Scientific leaders – O.S. Yutkina, O.I. Katina
Meningococcal disease is a bacterial infection causing two very serious illnesses:
meningitis and septicemia.
CLINICAL MANIFESTATIONS. Many people carry the bacteria in their noses and
throats without any clinical manifestations. They are called healthy carriers. Healthy
carriers can spread the bacteria to other people.
Meningococcal disease generally occurs in 1–10 days after the infection and results
in meningitis in ≥50% of cases. Meningococcal meningitis is characterized by sudden onset
of headache, fever, and stiffness of the neck, sometimes accompanied by nausea, vomiting,
photophobia, or altered mental status.
Up to 20% of people with meningococcal disease get meningococcal sepsis, known
as meningococcemia. Meningococcemia is characterized by a sudden onset of fever and a
petechial or purpuric rash. The rash may progress to fulminant purpura. Meningococcemia
often involves hypotension, acute adrenal hemorrhage, and multiorgan failure. Among
infants and children under 2 years old meningococcal disease may have nonspecific
symptoms. Neck stiffness, usually seen in people with meningitis, may not occur in this
age group. Other syndromes associated with meningococcal disease may include arthritis,
conjunctivitis, otitis media, urethritis, and pericarditis.
DIAGNOSIS. Diagnosis is generally made by isolating N. meningitidis from blood
or CSF (cerebrospinal fluid) through culture, by detecting meningococcal antigen in CSF
by latex agglutination, or by evidence of N. meningitidis DNA by PCR.
TREATMENT. Treatment as emergency care usually involves immediate
intramuscular injection of benzylpenicillin. And then a patient is transported to hospital for
further care. In the hospital the antibiotics are used. As a rule there is a wide choice, usually
broad spectrum of cephalosporins of the 3rd generation, e.g., cefotaxime or ceftriaxone.
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Supportive measures include infusion therapy, oxygen, inotropic support, e.g., dopamine
or dobutamine and decrease of high intracranial pressure. The injection of steroids is
possible.
PREVENTION. Several vaccines are registered in Russia: polysaccharide
(Meningococcal vaccine A; The polysaccharide meningococcal A + C (meningitis A + C);
Mencevax ACWY. Conjugated Vaccine - Menjugate). Vaccinations of children from 2
months to 18 years of high risk groups are carried out.
IL-17 – FRIEND OR ENEMY?
Omelich E., Tiku D., Savelieva K., Danko K. – the 4th year students
Scientific leaders – I.V. Kostrova, O.I Katina
Asthma was once thought to be a uniform disease triggered by one type of immune
cell. Researchers are now revealing the complexity of the condition and hope to invent new
drugs for unresponsive to steroids forms.
According to textbooks, type 2 helper T cells (Th2 cells) regulate asthma. T-cells
are a subset of the white blood cells known as lymphocytes. And asthma attack is
considered to occur when Th2 cells secrete a certain set of immune-signaling proteins
called cytokines. They inflame the lungs, irritate the chest and cause asthma's characteristic
wheezing. However, another cytokine, interleukin-17 (IL-17) that does not belong to Th2's
signature set, has been found in lung tissue, sputum and the blood of asthmatic
patients. The detection of IL-17 in the lungs of some asthmatics has drawn attention to IL17-producing cells previously thought unrelated to asthma.
Implicating IL-17 in asthma and proposing new disease subtypes has solved several
problems. For example, in many asthmatic patients the eosinophils (other types of white
blood cell) accumulate in the lungs. But in individuals with the most severe form of asthma
yet another type of immune cell – neutrophils present. Normally, these neutrophils, lured
there by IL-17, surround the area of an acute infection or injury to protect the body. In
asthma IL-17 appears to draw neutrophils into the lung — but they do not help with their
protection. Instead, they worsen asthma attacks.
Furthermore, compared to people with mild asthma, individuals with severe asthma
not only have more IL-17, but they tend to have more of the cells known to secrete IL-17,
so-called Th17 cells. Research has also shown that in a common treatment for asthma with
steroids mice with more Th17 cells get little breathing relief, but severe asthma patients
rarely respond to this therapy.
By secreting IL-17 and other cytokines, Th17 cells constrict the lungs' airways.
What triggers Th17 cells to churn out these lung-damaging molecules, however, is less
well understood.
Another possible factor in the role of Th17 in asthma is vitamin D. This vitamin
seems to slow the production of cytokines by Th17 cells. So a vitamin D deficiency may
lead to the over-production of cytokines by Th17 cells.
Personalizing asthma treatment
Figuring out what cells produce IL-17 in response to certain stimuli should help to
work out new medicines for asthma treatment in patients unresponsive to current steroid
therapy. In order to test any new drug, patients must be clearly classified in the forms of
the main pathology. Otherwise, a drug tailored for one form of asthma can be ineffective
in treating a different form of the disease.
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In the United States, the multicentre Severe Asthma Research Program (SARP) has
thus far assessed about 1600 patients and outlined three main types of severe asthma.
CAUSES OF PREMATURITY IN PEDIATRIC PRACTICE
Maltsevа I., Buryak L. – the 5th year students
Scientific leaders - Cand.Med.Sc. E.L. Chupak., O. I. Katina
Each year, as a result of spontaneous preterm birth or artificially induced abortion
in late pregnancy 5-10% of children of the total number of newborns are born prematurely.
Premature are considered to be children born before 37 weeks of gestation with a
birth weight less than 2500 grams and height less than 45 cm. As the World Health
Organization suggests viable children are those born weighing from 500g in 22 weeks.
Such infants have all the organs, and they can exist apart from the mother.
The causes for the birth of a premature baby can be: genetic abnormalities and fetal
malformations; late toxicosis; immunological incompatibility between mother and fetus
(Rh-conflict); maternal age younger than 18 and older than 35 years; insufficient or
inadequate maternal nutrition before and during pregnancy; general disease of a mother;
chronic (cardiovascular diseases and endocrine system, kidneys), acute infectious diseases
(SARS, influenza);mother gynecological diseases, including infections, sexually
transmitted infections, most syphilis, gonorrhea, cytomegalovirus, a viral infection, herpes,
ureaplasmosis, trichomoniasis; uterine changes (scars after surgeries, including caesarean
section, uterine fibroids, chronic endometritis);cervical incompetence when, after previous
unsuccessful delivery or abortion the cervix does not fully close, but remains slightly open,
and the fetus is not retained in the uterus; mother's bad habits (smoking, alcohol
abuse);occupational hazards; maternal injuries, including psychological.
PEAK FLOWMETRY AS A METHOD OF BRONCHIAL ASTHMA CONTROL
Buryak L., Maltsevа I. – the 5th year students
Scientific leaders - Cand.Med.Sc. I.V. Kostrova, Cand.Med.Sc. S.A. Goryacheva, O. I.
Katina
The success of treating asthma is a good medication, convenient inhalers and
effective cooperation between the asthmatic patient and his doctor. Peak flowmetry will
help you actively participate in the control and treatment of asthma.
Peak flowmetry is a method of study of peak expiratory flow (PSV), i.e. the
maximum speed at which a person can exhale after a full inhalation. This is an important
indicator for bronchial asthma, because bronchial constriction manifests itself primarily by
a decrease in expiratory flow.
Peak flow meter – is a portable, simple and affordable device: a plastic tube with a
mouthpiece in which it is necessary to blow. The air flow moves on the arrow to the scale,
which indicates the value of PSV.
There are different types of peak flow meters. To track the dynamics of PSV, it is
important to use the same device as the PSV values may vary when using different devices
by almost 20%.
Normal PSV values of different people can vary up to 30%, so PSV is better to
compare with the individual values measured on the same peak flow meter. Individual PSV
rate is the maximum PSV value registered 5 times or more in good health, including the
treatment of hormonal drugs. For its determination it is necessary to measure PSV in the
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next 2-3 weeks at least once a day after noon. Every six months this indicator should be
reassessed considering the progression of the disease, as well as the growth of children. If
peak flowmetry is made for the first time or there are no data about individual PSV norm,
it is possible to use the average calculated norms (called nomograms). They are calculated
for all types of peak flow meters depending on height, race, gender and age and are located
to the device.
To keep a special diary for self-monitoring and to note daily the symptoms and the
results of PSV is very important for the successful treatment of asthma. The peak
flowmetry is taken twice a day with an interval of 10-12 hours in the morning, immediately
after waking up and before the inhalation of bronchodilator drugs when the values of PSV
are close to the worst values and in the evening after inhalation when the values of PSV
reach their best values. Every time one needs to measure PSV three times to choose the
maximum value and mark it on the chart in the appropriate column - the morning or
evening of a particular date.
The earliest sign of exacerbation of asthma – is a stable decrease in the morning
values of PSV, the so-called “morning dip”. In the comments to the diary one should record
the circumstances which could affect the course of asthma: the common cold, physical
exercise, contact with a possible allergen, a change in therapy, etc.
The main benefits of regular peak flowmetry are: 1) diagnosis of asthma; 2)
identification of factors triggering asthma; 3) self-control of asthma; 4) early detection of
exacerbations; 5) evaluation of the effectiveness of the therapy.
The peak flowmetry should not be considered as an alternative to measurement of
respiratory function. This is the method of assessing pulmonary function, which has its
own niche - the self-control of asthma. Peak flowmetry allows asthmatics to cooperate
better with the doctor, and in worsening of the condition - to self-regulate the treatment. It
definitely decreases the dependence on sickness and gives the opportunity to have more
active lifestyle what is difficult to overestimate in modern conditions.
THE INCIDENCE OF HIV INFECTION IN RUSSIA AND THE AMUR REGION
Nogai V., Buryak L., Rozhkova E. – the 5th year students
Scientific leaders – O.A. Agarkova, O.I. Katina
According to experts at present Russia is under a generalized HIV epidemic. It
means that the disease spreads beyond the high-risk groups. From 2007 to 2015 the number
of new cases among Russian citizens has increased from 44 to 93 thousand per year and
continues to grow. At 07.01.2016, 1057042 persons with HIV were registered in Russia.
More than 200000 died. In Yekaterinburg every 50th citizens is infected with HIV: 1826
people per 100 thousand of the population, i.e. 1.8 percent of the population. Doctors say
that this is just officially registered cases. Actual number is usually higher.
Doctors have concluded that the disease has penetrated the prosperous layers of the
population. Now the patient with HIV - is not necessarily a drug addict or a young man.
In 2015, 130 cases of HIV infection in Russia were registered, including 89 cases
among citizens of the Amur region. Most cases of HIV infection were in the age group 2039 years. They accounted 77.1% for the entire period of registration. Since 2000, cases of
HIV infection among 16-19 years old people have been registered each year (3%). This
fact indicates a risk behavior among the general population of reproductive age. Among
HIV-infected patients in the Amur region throughout the years of registration men are
dominated. Currently the proportion is 61.7%.
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The Amur region refers to areas with low levels of morbidity. The region has an
unstable population, low population density and high rates of migration. It has an impact
on the nature of the HIV epidemic.
RELEVANCE OF ENDOSCOPIC SURGERY IN THE WORLD OF MODERN
TECHNOLOGY
Prokofyeva N. – the 3rd year student
Scientific leaders – Doc.Med.Sc. V.V. Grebenyuk , O.I. Katina
Actuality: Endoscopic Surgery – is a modern alternative to the classical wide access
surgery. When performing an open surgery the surgeon needs to make the cut, providing
an access to the organs in which the operation is done. Until recently, the section of the
body covering tissue was the only method that allowed the surgeon to perform the
operation.
Today, endoscopic technique eliminates the need to make large incisions.
Operations are carried out with the help of tools, manipulators, that are introduced into
organs or cavities through small incisions (punctures) or natural physiological holes due to
the endoscope and other flexible fibroapparatus (complex optical systems that are
connected to the camcorder). This allows the surgeon to control the instruments and
perform manipulation under visual control while looking at the monitor.
Currently Endosurgical technology is widely spread throughout the world. The new
method enfolds many surgical specialties. The greatest progress has been made in the
treatment of gallstone disease and gynecological diseases, where the advantages of
endosurgery are manifested most clearly. One of the most important advantages compared
to conventional operations are the following:
1) reduction of traumatism of surgery. The amount of dissected tissue, blood loss
and the magnitude of the pain after surgery are much smaller;
2) reduction in the incidence and severity of complications;
3) less infection of operating area;
4) reduction of the duration of hospital stay after surgery;
5) period of disability and return to normal life is shorter in 3-4 times;
6) decrease in the cost of treatment by reducing hospital period, consumption of
drugs and the rapid rehabilitation of the patient;
7) cosmetic effect is extremely important, especially for the female population.
Increasingly, endoscopic surgery is becoming the subject of patient choice. We
carried out a survey of 2nd year students on the theme: "The choice between traditional
and endoscopic operations in the need of its emergency and the reasons for choosing (eg.
appendectomy and cholecystectomy)". For scientific research 100 people were included in
the group of 2nd year students. They had already been acquainted with the concept of
endoscopic surgery.
Results: 85% would choose endoscopic surgery. The most common causes are a
small traumtism and better cosmetic effect. At the same time, 14% would prefer the
traditional method of operation considering it to be a proven and reliable. 1% would rely
on the choice of doctor without singling out one method of operation to another. Professor
of the Department of Anatomy and Operative Surgery Doctor of Medical Science, V.V.
Grebenyuk constructed a medical trainer of his own design to develop the skills of
Endoscopic Surgery (RF patent for the invention № 147842 from 10.16.2014). The purpose
of the medical simulator was to develop a base of manual laparoscopic skills, motor
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coordination training and the adaptation of the visual analyzer to the two-dimensional
image on the screen.
Conclusion: Thus, the role and place of the modern endosurgery is determined not
only by a variety of possibilities of endoscopic techniques, but also the understanding of
the need for further development of the method, the constant emergence of new techniques
of endoscopy and high professional level of medical personnel working in the profession.
Further development of the students' practical training in the field of endosurgery will
improve their professional level in the future and motivate students to increase the number
of medical staff in this area.
THE MORPHOLOGY OF THE FEMALE PELVIS AT THE AGE OF 16-25 YEARS
Ostapenko Ya, Urmancheeva V. – the 2nd year students.
Scientific leaders - Cand.Med.Sc. S.S. Seliverstov, O.I.Katina
Bone pelvis is a solid container for internal hollow organs and surrounding tissues.
Female pelvis forms the birth canal through which the fetus is born.
Differences of female pelvis from the male one begin to be detected at puberty and
are distinct in adulthood.
The pelvis is made up of four bones: two pelvic, sacrum and coccyx.
Pelvic (unnamed) bone (os coxae). Up to 16-18 years it is composed of three bones
connected by cartilages: iliac, ischiatic and pubic. At 25 years after ossification cartilages
accrete together forming a nameless bone.
Flank bone (os ilium) has two parts: the body and the wing. The body makes short
and thickened part of the bone, and participates in the formation of the cotyloid cavity.
Knowledge of sizes of the external pelvis is very important in obstetrics as they are
used while defining the size of the pelvis. Measurements are made with pelvimeter. There
are four sizes: three transverse and one straight.
Distantia spinarum - the distance between the anterosuperior axes of iliac bones. It
is typically 25-26 cm.
Distantia cristarum - the distance between the most distant points of the iliac crests.
Usually it is 28-29 cm.
Distantia trochanterica - the distance between the greater trochanters of femur. It
makes 30-31 cm.
Conugata externa - outer conjugate, i.e. the straight pelvis size. A woman is laid on
its side, the underlying leg is bent at the knee and hip joints, the overlying one – is pulled.
Buttons of one branch of pelvimeter is set in the middle of superexternal edge of
symphysis. The other end is pressed against the suprasacral pit that is located between the
spinous processes of the 5th lumbar vertebra and the beginning of the middle sacral crest
(suprasacral fossa coincides with the upper corner of the sacral crest). In norm it is 20-21
cm.
Conugata vera - true conjugate. To determine conugata vera it is necessary to
subtract 9 from the outer conjugates, then we get the true size. The difference between the
true and the outer conjugates depends on the thickness of the sacrum, symphysis and soft
tissue. So the difference is not always exactly correspond to 9 cm. Or it is possible to
subtract 1.5-2 cm from the size of diagonal conjugate.
Conugata diagonalis - - diagonal conjugate – is the distance from the lower edge of
the symphysis to the most prominent point of the promontory of the sacrum. It is
determined by vaginal examination. When normal pelvis it is 12.5-13 cm.
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SCOLIOSIS IN PEOPLE AGED FROM 16 TO 25 YEARS
Podgorbunskaya E., Moiseenko A. – the 2nd year students
Scientific leaders – Cand.Med.Sc. S.S. Seliverstov, O.I.Katina
Scoliosis is the abnormal curvature of the spine causing the deformation of the spine
and rib cage.
Frequency. In 75% of cases the etiology of the disease in younger people is
unknown.
The code of the International Classification of Diseases is ICD-10:
M41 Scoliosis
Causes - Etiology
• I group: scoliosis of myopic origin. The basis of curvature is developmental
disorders of muscle tissue and ligaments
• II group - neurogenic scoliosis (on the background of poliomyelitis,
neurofibromatosis, syringomyelia, etc.).
• III group (congenital scoliosis) - scoliosis on the basis of vertebral and rib
malformations (wedge-shaped additional vertebrae, unilateral synostosis of ribs and the
transverse processes of the vertebrae)
• IV group - scoliosis due to the thorax and spine diseases (scarring after empyema,
burns, plastic surgery, trauma)
• V group - idiopathic scoliosis.
Symptoms, signs - Clinical picture
• I degree scoliosis - a slight lateral deviation of the spine and a small degree of
torsion, detected radiologically; angle of primary arc of curvature – is no more than 10 °
• Scoliosis of II degree - a significant deviation of the spine in the frontal plane,
expressed torsion; angle of primary curvature arc is in the range of 20-30 °
• III degree scoliosis - severe deformation, large costal hump, deformation of the
chest; angle of primary curvature arc – is 40-60 °
• IV degree scoliosis - expressed deformation of the trunk, the thoracic spine
kyphoscoliosis, pelvic strain, deforming spondylarthrosis. The angle of primary curvature
reaches 60-90 °, pulmonary - cardiac complications are possible.
Diagnostics
• The examination is necessary to determine the cause of scoliosis. It is made in
forward and flexed positions of the patient's back. Thus it is necessary to pay attention to
asymmetry of the spine, scapula and muscles. The symmetry of the shoulders and hips is
checked, the length of the legs is measured.
• It is required to carry out the X-ray of the spine in two projections in the horizontal
and vertical positions of the patient's body. X-ray can determine any curvature of the spine
greater than 10 °.
SPASTIC STRUMPELL’S PARAPLEGIA
Lapanik T. – the 4th year student
Scientific leaders - Doc.Med.Sc. V. N. Karnaukh, O.I.Katina
Hereditary spastic Strumpell’s paralysis – is a chronic progressive hereditary
degenerative disease of the nervous system characterized by bilateral lesion of the
pyramidal tracts in the lateral and anterior spinal cord.
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Causes. The disease in most cases is inherited with autosomal or dominant
inheritance types.
Pathology. Most often the lumbar and thoracic spinal cords are affected, rarely - the
brain stem. Hereditary spastic paraplegia is characterized by glial degeneration of the
pyramidal tracts in the lateral and anterior cords on thoracic and lumbar levels of the spinal
cord, Gaulle’s bundles.
The clinical picture. The development of disease is gradual, it progresses slowly.
Often the first symptoms appear during the second decade of life. Spasticity usually
prevails over the phenomena of paresis. Complete paralysis usually is not observed.
Characteristic spastic gait develops, varus and equinovarus feet deformity appear, tendon
and muscle contractures. Central paraparesis of the lower extremities develops. Cutaneous
reflexes in most cases remain; pelvic organ functions are not affected. Disorders of
sensitivity are absent. Intellect is preserved.
Patient - 10 years old. Complaints according to his mother: a change of gait. Child
is from 1 pregnancy. He grew and developed according to his age. The first signs of the
disease appeared at the age of 2. Parents noticed that the child began to walk on
tiptoes. Heredity: the patient's father has the similar pathology.
The disease developed gradually, with the progression of the central paraparesis of
the lower extremities. There was no prolonged effect from the treatment. Surgical treatment
was aimed at eliminating the orthopedic defect: 4 years - achilloplasty (Achilles tendon
lengthening) on the right foot, in 4 achilloplasty was done on the left leg. In 2015 he was
made the injection of the calf muscles with Botox, physiotherapy, massage, exercise
therapy. In 2015 the operation by Ulzibat method was performed (elimination of muscle
contractures).
Intellect is preserved, sociable, the syndrome of attention deficiency with
hyperactivity. Cranial nerves are without pathology.
Paraspastic gait. Active and passive movements in the distal and proximal parts of
the lower limbs are limited due to the ankle joint contractures, hypertonus of proximal part
of lower extremities, decrease of muscular strength in both limbs. There is a moderate
hypotrophy of right thigh muscles. Posture is changed, lumbar lordosis is pronounced.
Tendon reflexes: the knee and ankle are elevated on both sides. There is the Babinski
syndrome on both sides. All kinds of sensitivity are kept. He is slightly unstable in
Romberg’s posture. Finger - nose test is not broken. Heel-knee test is performed with
difficulty. Speech is not changed. The functions of the pelvic organs are not violated.
Conclusion. The peculiarity of the case is that the disease started to develop at an
early age (about two years) and resulted in significant violations of walk, early
development of contractures. That required the surgery and orthopedic correction.
TOOTH STRUCTURE AND ITS CHANGES DURING THE LIFE
Matyushonok A. – the 2nd year student
Scientific leaders - V.S. Kozlova, O.I.Katina
Teeth - are the structures necessary for normal human life requiring a thorough and
careful handling. Deciduous tooth is laid at the end of the 2nd month of fetal development.
Later on there is the foundation of a permanent tooth. Initially they are placed in a common
bone alveolus. Eventually osseous septum is formed between them. Teething occurs
differently: first teeth begin to erupt at 6-8 months of age. Then their active replacement
on permanent begins at the age of 6 years.
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Enamel – is the hardest tissue of the human body covering the crown of the tooth
outside and protecting the dentin and pulp from external stimuli. It contains 95% of
minerals (hydroxyapatite, fluorapatite, carbonateapatite), 1.2% of organic, and 3.8% of
water. Enamel functions are: protective, trophic (tooth-CSF).
Dentin – is a calcified dental tissue penetrated with dentinal tubules. It forms its
bulk and form. The crown area is covered with enamel and in the root area there is cement.
Dentin contains 70% of inorganic substances (hydroxyapatite), 20% of organic (collagen
type 1), 10% of water. Intercellular substance is collagen fibers bound with hydroxyapatite
crystals. Functions of dentin: protective, supportive, reparative, passive eruption.
Pulp – is a loose fibrous connective tissue with a large number of nerve endings,
blood and lymph vessels. It fills the cavity of the tooth. Pulp cells – are odontoblasts,
fibroblasts, to a lesser extent - macrophages, dendritic cells, lymphocytes, plasma and mast
cells, eosinophilic granulocytes.
Change of teeth occurs between the ages of 6-12 years and begins with the eruption
of permanent tooth and the subsequent loss of the milk one. The rudiment of permanent
tooth begins to grow and pressures on the osseous septum separating it from the milk tooth;
simultaneously osteoclasts activate and break down the bone septum and the root of the
first tooth. As a result the growing permanent tooth pushes the remaining crown of the milk
one and erupts.
When there is a complex influence of unfavorable external and internal factors on
the tooth, the tooth decay may develop. Caries is a pathological process manifesting in
demineralization and progressive destruction of hard tooth tissue with the formation of a
defect in the form of a cavity in the dentin. The destruction of the hard tissues of the tooth
takes place with the participation of microorganisms that may gradually lead to
inflammation of the dental pulp, and its necrosis - pulpitis and tooth destruction.
PRECANCEROUS DISEASES OF THE CERVIX
Gracheva D.-the 3rd year student
Scientific leaders – Doc.Med.Sc. I.Y. Makarov, A.I. Patrokov, O.I. Katina
Cervical cancer is the malignant degeneration of epithelial tissue of the cervix in the
form of various exophytic, or endophytic infiltrating growths capable of infiltration of
surrounding tissues and metastasis to distant organs. The proportion of cervical cancer
among cancer of the genital organs is 70-80%. Age of women affected with cervical cancer
is 40-60 years. Contributing factors are generic and abortion trauma, violation of ovarianmenstrual function, chronic inflammatory processes.
Also higher factors of cervical cancer include:
- infection of sick human with papillomavirus (HPV), as well as genital herpes
viruses and cytomegalovirus;
- the use of hormonal contraception and the rejection barrier one (condom,
contraceptive caps);
- earlier initiation of sexual activity - from 13 to 18 years of age;
- frequent change of sexual partners;
- smoking.
The human papillomavirus (HPV) is a common virus that causes a variety of
diseases for both women and men.
At present there are about 100 different types of human papilloma virus. Different
types of virus can cause various diseases.
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About 30 types cause damage of the female genital organs.
The most dangerous of them are the types of human papilloma virus with a high
cancer risk – i.e. the virus with the greatest ability to cause cancer of the reproductive
organs, particularly cervical cancer. Such viruses include human papilloma virus (hpv) 16,
18, 31, 33, 35, 39, 45, 51 and 52 types.
The most important manifestations of human papilloma virus infection in women
are pointed and flat condylomas, dysplasia and cervical cancer.
Cervical erosion – is a violation of integrity, ulceration or defect in the mucous
membrane of the vaginal part of the cervix. It may occur in women of any age and requires
a thorough examination and timely treatment, as cervical erosion may be an early
precancerous or cancerous changes in the epithelium. Patients with the human papilloma
virus (HPV) of the high-risk types (16, 18, 31, 33 type) cause particular caution. In this
case, the risk of cervical cancer increases in several times.
When viewed in the mirrors the erosion looks like the area of red color located
ostium of the uterus, different size from 2 mm to 2 cm. Pseudo erosion can exist for months
and years.
Leukoplakia –a dystrophic disease resulted in a change of the mucous membrane
accompanied by cornification of the epithelium.
It is characterized by the appearance in the vulva area dry white plaques of various
sizes. They are the areas of increased keratinization with subsequent sclerosis and scarring
of tissues. In addition to the vulva, leukoplakia can be localized in the vagina and on the
vaginal part of the cervix.
MORPHOFUNCTIONAL CHANGES IN THE IMPLANTATION
ARTIFICIAL HEART VALVES
Krasulina E., Lokonov R. – the 3rd year students
Scientific leaders – Doc.Med.Sc. I. Y. Makarov, S. A. Peschanskaya, O. I. Katina
OF
At violation of any of the 4 heart valves — their narrowing (stenosis) or excessive
extension (failure) — there is a possibility of their replacement or reconstruction with
artificial analogues. Artificial heart valve is a prosthesis that provides the desired direction
of blood flow by the intermittent overlapping of the ostia of the venous and arterial vessels.
The main indication for the prosthesis is an abrupt change in the valve cusps leading to
significant violation of blood circulation.
There are two main types of artificial heart valves: mechanical and biological
models. Each of them has their own characteristics, advantages and disadvantages.
Mechanical heart valve is reliable, durable and does not need to be replaced. But it requires
constant use of specific medicines that reduce blood clotting. Biological valves may
gradually deteriorate. The duration of their work greatly depends on the patient's age and
comorbidities. With age, the process of destruction of biological valves is significantly
reduced. The decision about which valve is most appropriate should be made before
surgical intervention, during the obligatory conversation between the surgeon and the
patient.
People with prosthetic heart valves belong to the category of patients with very high
risk of thromboembolic complications. The fight against thrombosis is a basis of strategy
of management of such patients. And its success largely determines the prognosis. Life
with an artificial heart valve requires a number of restrictions. The patient has to take
antithrombotic drugs, in the vast majority of cases - indirect anticoagulants. They should
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be taken by almost all patients with mechanical heart valves. The choice of biological
prosthesis does not preclude the need for use of Warfarin, especially in patients with atrial
fibrillation. In order to avoid dangerous bleeding, patients constantly taking Warfarin
should better avoid daily activities and entertainment associated with an increased risk of
injury (contact sports, working with cutting items or high risk of falls even with his own
height).
The most important aspects of medical monitoring of the patient with an artificial
heart valve include: control of blood clotting; the active prevention of thromboembolic
complications using anticoagulation. It is important to note that currently European and
American experts believe the levels of antithrombotic therapy to be too intense, though
previously they were recommended for the majority of patients. Modern approaches to risk
assessment allow to select subgroups of individuals at highest risk of thromboembolic
complications and active antithrombotic therapy. For other patients with prosthetic heart
valves less aggressive antithrombotic therapy is sufficiently effective.
FEATURES OF CLINICAL COURSE OF RARE FORMS OF ERYSIPELAS
Shpinyov A. - the 5th year student
Scientific leaders - T.A. Dolgih, O.I.Katina
Erysipelas - (pol. roza - Rose) – is an infectious anthroponosis disease caused by a
B - hemolytic streptococcus of group A. It occurs in the acute (primary) or chronic
(recurrent) form with the expressed intoxication syndrome, skin manifestations and
lymphadenitis.
According to statistics, currently the incidence of erysipelas in the European part of
Russia is 150-200 per 10 000 population. In recent years there has been the rise of the
incidence in the United States and some European countries. At present patients under the
age of 18 years are registered only singular cases of erysipelas. From the age of 20 the
incidence increases. And in the age range from 20 to 30 years men are infected more often
than women due to the predominance of the primary erysipelas and professional factor.
The majority of patients - are those aged 50 years and older (up to 60-70% of all cases).
The incubation period lasts from a few hours to 3-5 days. The disease begins with a
headache, general weakness, fever, myalgia, nausea and vomiting (25-30% of patients). In
the first hours there is an increase of the temperature up to 38-40 ° C. After 1-2 days,
symptoms of the disease are at their maximum. For the erysipelas of the scalp the intense
headache in the inflammatory focus is characteristic. It is hidden by hair, without erythema.
Erysipelas of the upper limbs is rare (5-7% of patients). It develops on the background of
postoperative lymphostasis in women operated on for breast cancer. Erysipelas of
perineum and genital skin is characterized by edema in men - the scrotum and penis, in
women – large pudental lips. Periodic erysipelas occurs in women during each menstrual
period, but with the onset of menopause there are continuing episodes of recurrences
replacing menstruation. During "gelatin" Virchow’s erysipelas arising due to lymphostasis,
the skin is blond-yellow, crimson or brown. Erythema is slight. White erysipelas of
Rosenberg-Unna develops in patients with tuberculosis, syphilis, leprosy. It manifests by
soreness and violent skin edema. Erythema is absent. Erysipelas of newborns often starts
with the umbilicus or toes. It has the ability to migrate ("traveling erysipelas", "wandering
erysipelas"). Erythema is not intense. Swelling, infiltration of the skin and subcutaneous
tissue are observed at all times. The edges of the lesion have a twisted contour, but the
limiting torus is not expressed. The disease begins with high fever and chills. There are
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dense areas of skin hyperemia, warm to the touch. Sometimes the onset of the disease can
be insidious - without or with a slight increase of the temperature. Then the disease
progresses. The child becomes flaccid, refuses the breast, there are digestive disorders,
phenomena of myocarditis, nephritis, meningitis, and sepsis develops. The mortality rate
of newborns from erysipelas is extremely high. Erysipelas is equally dangerous for children
in the first year of life. The criteria for the severity of erysipelas are considered to be the
severity of intoxication and the prevalence of the local process.
Therefore, considering the prevalence of the disease, the risk development of
atypical manifestations and localization process, relapsing forms, severe course in
newborns, there is a need of methods for rapid diagnosis, timely causal therapy and
patients' adherence to the prevention of erysipelas.
PECULIARITIES OF CLINICAL COURSE OF HAEMOPHILIC MENINGITIS IN
CHILDREN
Pakhomov S. – the 5th year student
Scientific leaders - T.A. Dolgih, O.I.Katina
Haemophilic meningitis – is an acute anthroponosis infectious disease with aerosol
mechanism of transmission. It is characterized by a primary lesion of the respiratory tract
and the brain membranes.
The urgency of the problem of haemophilic meningitis is due to the fact that this
pathology takes the second place in the structure of bacterial meningitis in children under
5 years. There is often a long and undulating course of the disease and a high incidence of
residual effects and adverse effects, such as the progression of hydrocephalic-hypertensive
syndrome and hearing loss. Certain value has a relatively late appearance of meningeal
syndrome leading to diagnostic difficulties and frequent hospitalization in non-core
hospitals.
The causative agent - is the bacterium Haemophilus influenzae type of Haemophilus
(Pasteurellaceae family). The sources of infection – are patients with any clinical form of
Hib-infection, as well as healthy carriers. Susceptibility is due to the lack of human
immunity and the anatomical and physiological characteristics of children under 5 years.
Haemophilic meningitis develops most often on the burdened premorbid
background: organic CNS lesions - 42.7%, frequent acute respiratory diseases - 34.8%,
pathology of pregnancy and childbirth - 20.3%. The disease begins subacute: a cough,
runny nose, and increase of body temperature to 38-39 ° C. In some patients in the initial
period dyspepsia may dominate. This period lasts from several hours to 2-4 days. Then the
child's condition worsens: enhanced intoxication syndrome, disorders of consciousness,
convulsions, and in 1-2 days - focal symptoms, body temperature reaches 39-41 ° C,
increasing headache, vomiting, meningeal symptoms. Fever in Haemophilic meningitis is
often remittent or irregular. It is registered even on the background of antibacterial therapy,
the average duration 10-14 days. Catarrhal symptoms in the form of pharyngitis are noted
in more than 80% of patients. Often there is hepatosplenomegaly, lack of appetite,
confusion of consciousness, weakness. Focal neurological symptoms are seen at least in
50% of patients. Often there is paresis of cranial nerves, hearing impairment, focal seizures,
ataxia, muscle tone disorders for extrapyramidal type, rarely paresis of the extremities.
Meningeal syndrome (e.g. protrusion of cerebellum) and hanging symptom are expressed
moderately. Neck stiffness of muscles is usually typical for children older than 1 year. And
Brudzinsky and Kernig symptoms in some patients are mild or absent.
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The most accurate diagnosis is to identify the causative agent from blood and CSF
during bacteriological examination, RAL and PCR.
Drugs of choice for the treatment of Haemophilic meningitis are Ceftriaxone and
Meronem. In the absence of the effect fluoroquinolones of the second generation
(Pefloxacin, Ciprofloxacin, Ofloxacin) or a combination of cephalosporin (Ceftriaxone)
and fluoroquinolones are administered.
Thus, considering the prolonged and sinuous course of the disease, a high risk of
residual effects and adverse effects, it is necessary to pay more attention to timely
vaccination of the disease.
A CASE OF SUCCESSFUL TREATMENT OF JUVENILE RHEUMATOID
ARTHRITIS WITH GENETIC ENGINEERING BIOLOGICAL DRUGS
Abuldinov A., Abuldinova O., Safronova D. – the 6th year students
Scientific leaders – Cand.Med.Sc. M.V. Pogrebnaia, O.I. Katina
Patient S., 18 years old, was admitted on 24 March 2016 in the rheumatology
department of the Amur regional clinical hospital with clinical diagnosis: Rheumatoid
arthritis, seropositive, deployed stage, activity I, non-erosive (radiographic stage 1), ACCP
(–), FC I; complications: secondary amyloidosis with renal impairment, osteoporosis with
pathological fractures.
The patient had been ill since 2006, when pain in the ankle and knee joints appeared
for the first time. Over the next year the condition worsened accompanied by pain in the
wrist joints, there was swelling of the knee and limitation of motion in the aforementioned
joints. He was examined in the cardiology department of the Amur regional children's
clinical hospital. Diagnosis: Juvenile rheumatoid arthritis. Treatment with prednisolone at
a dose of 30 mg/day, showed a slight effect. In 2007, the pulse therapy treatment with
methylprednisolone 1000 mg No3, cyclophosphamide at a dose of 1000 mg No2 (1 per
month), prednisone 1.5 mg/kg/day was made. The patient constantly took methotrexate at
a dose of 10 mg/week in combination with folic acid. In 2008, there were pronounced
swelling on the face in the periorbital area and on the feet. The examination revealed
massive proteinuria, hydrothorax and hydropericardium. A patient was directed to Russian
children's clinical hospital in Moscow for further examination, diagnosis and determining
further management of patients. A biopsy of the kidneys was made and due to its results
the diagnosis was: Juvenile rheumatoid arthritis. Secondary renal amyloidosis. In 2012, in
the RAMS Institute of Rheumatology the diagnosis of rheumatoid arthritis, secondary
amyloidosis of the kidneys was confirmed. Since 2014 the patient receives infliximab at a
dose of 200 mg 1time every 8 weeks. The present hospitalization is planned in connection
with the achievement of the age of eighteen and the transition under the supervision of an
adult rheumatologist.
By the results of additional methods of examination there is no clinical, laboratory
and radiological disease activity at the moment. The patient continues to receive treatment
of methotrexate 15 mg per week in combination with folic acid 5 mg per week, infliximab
200 mg 1 time every 8 weeks via intravenous infusion pump.
The interest of the case lies in the fact that the early onset of active basic treatment
of juvenile rheumatoid arthritis prevented the progression of destruction of joints, disability
of the patient, neutralized the manifestations of amyloidosis and nephrotic syndrome and
improved the quality of life in general.
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FASCIAE OF UPPER EXTREMITIES AND WAYS OF PURULENT INFECTION
SPREAD
Chernikova P., Nevedomskaya O., Mihailov I. – the 2nd year students
Scientific leaders – Cand.Med.Sc. S.S.Seliverstov, O.I.Katina
Fascia – is a connective tissue tunic covering various organs, mainly muscle.
Collagen and elastic fibers intersect with each other in different directions forming at the
same time the separate layers. There are typically numerous blood vessels, lymph, spaces,
fissures, vessels as well as nerves in the mass of the connective tissue. Its vessels deliver
nutrition to the muscles and organs causing the tissue exchange between them. Fasciae also
play an important role in pathological processes in the body.
The source of the fasciae in embryogenesis is mesenchyme turning into a loose
unformed tissue. The process of fasciae forming is in indurations of the embryonic tissue
and development in it connective tissue fibers, produced by young connective tissue cells
- fibroblasts.
Fasciae of limbs are surrounded by muscles or groups of muscle, forming for them
fascial or osteofascial cisterns. Fasciae covering the upper limb differ in thickness. Fascial
plates in some places form a well-defined the sheaths and line holes and channels of
different size. The fasciae of the upper limb consist of fasciae of the girdle and free upper
limbs. In the area of girdle of the upper limb there are the following: a) deltoid, b)
supraspinal, c) infraspinal, g) subscapular. Axillary fascia. Shoulder fascia. The fascia of
the forearm. Fascia of a hand.
There are several functions of fascia: biomechanical (support); protective (barrier);
nucleating; reparative.
Possible pathways of pus from the primary tumor (streaks) in the adjacent field
divided into two groups: primary and secondary. Primary - purulent processes occur
without destruction of the anatomical structures, the gradual "melt" in the natural fiber and
interfascial and intermuscular spaces, often under the influence of gravity in the lower
located parts of the body. Secondary accompanied by the destruction of the anatomical
elements and structures, a breakthrough, from one relatively closed fascial sheaths, or
intermuscular intervals to neighboring. This process is associated with the virulence of
microorganisms, their proteolytic activity, and also the state of the patient's immune
system.
FEATURES OF INGUINAL SPACE STRUCTURE
Volodina I., Kolesov B. - the 3rd year students
Scientific leaders – Cand.Med.Sc. S.I. Piskun, O. I. Katina
In herniology the problem of forecasting of inguinal hernias occurrence is still
relevant. At present surgeons are deeply aware of the producing factors of inguinal hernias,
while predisposing factors are not well studied. That was the basis for realization of this
study.
Chernykh A.V., Liubykh E.N., Zakurdaev E.I., Popov M.P. particularized the data
of variant anatomy of the inguinal space with the new linear parameters of anatomical
structures of the inguinal canal. The work was carried out on the floating corpses of 123
people who died suddenly from diseases not related to the pathology and abdominal
injuries.
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1. When slotted oval-shaped inguinal space, the height was 1.3 (1.1, 1.6) cm, length
- 5.5 (5.2; 6) cm, and the area - 5.3 (4.4; 5.5) cm2. The width of the falciform aponeurosis
was 2.6 (2.3, 2.8) cm.
2. Oval-transitional forms of inguinal space. Height was 1.5 (1.3; 1.7) cm, length 5.6 (5.1; 5.8) cm, and the area - 5.2 (4.8; 5.5) cm2. The width of the falciform aponeurosis
was 2.7 (2.4; 3) cm.
3. When the triangular shape of the inguinal space, the height was 2.7 (2.5; 2.8) cm,
length - 6.2 (6; 6.4) cm and the area - 6.6 (6.1; 6.8) cm2. The width of the falciform
aponeurosis was 1.6 (1.5; 2) cm.
Conclusion: The structure of the inguinal space was concretized. Its forms differ in
variability of structure of the lower edges of the internal oblique and transverse abdominal
muscles, the size and width of the sickle-shaped fascia. That is important to consider to
practicing surgeons.
GALACTOSEMIA
Mikhailov I. – the 2nd year student
Scientific leaders – Assoc.Prof. E.V.Egorshina, O.I.Katina
Galactosemia – is an inherited disorder of metabolism caused by deficiency of
activity of enzymes involved in galactose metabolism. In pediatrics and genetics
galactosemia refers to a rare genetic disease occurring with a frequency of one in 10 000 50 000 of newborns.
The transformation of galactose to glucose (the metabolic pathway of Leloir) occurs
with the participation of 3 enzymes: galactose-1-phosphatidylserine (GALT),
galactokinase (GALK) and uridinediphosphate-galactose-4-epimerase (GALE). In
accordance with the deficit of these enzymes the 1 (classic version), 2 and 3 types of
galactosemia are distinguished.
The allocation of three types of galactosemia is not the same as the order of action
of enzymes in the metabolic process of the Leloir’s way. Galactose enters the body with
food, and also is formed in the intestine by hydrolysis of the disaccharide lactose. The way
of galactose metabolism begins with its conversion by the enzyme GALK into galactose1-phosphate. Then, with GALT assistance the galactose-1-phosphate is converted into
UDP-galactose (uridyldiphosphogalactose). Then, using the GALE the metabolite is
transformed into UDP – glucose (uridyldiphosphoglucose).
On the severity of the clinical course there is severe, moderate and mild
galactosemia.
Complications of galactosemia include liver cirrhosis, sepsis, hemorrhage into the
vitreous, primary amenorrhea, and the syndrome of exhaustion of ovaries. If galactosemia,
in 50% of preschool children a motor alalia is revealed. It is characterized by the difficulty
of organization and coordination of speech movements, poverty of vocabulary, an
abundance of paraphasia and perseveration in intact understanding of reversed speech.
To reduce the risk of development of complications in galactosemia the early
detection of the disease is necessary. Prenatal diagnosis of galactosemia is possible. It
includes the conducting of chorionic villus sampling, amniocentesis with subsequent
investigation of villi and amniotic fluid.
The main role in the treatment of galactosemia belongs to the diet. Feature of food
in galactosemia is life-long exclusion from the diet foods containing lactose and galactose:
any milk (female, cow, goat, infant formula, low-lactose mixtures, etc.), all dairy products,
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bread, pastries, sausages, candies, margarines, etc. With galactosemia it is forbidden to take
vegetable and animal products containing potential sources of galactose, and galactosides
(beans, soy) and nucleoproteins (kidney, liver, eggs, etc.).
Children with galactosemia get the disability.
THE CLINICAL CASE OF ANGELMAN SYNDROME
Blokhina E.– the 5th year student
Scientific leaders – Cand. Med. Sc. O.S. Yutkina, O.I. Katina
Angelman syndrome is a chromosomal pathology localized in the 15th chromosome
and manifested in severe delayed of psycho - speech and motor development, coordination
disorder, behavioral disorders, the particular qualities of the emotional sphere ( "happy"
face in combination with laughter bursts, smiling, credulity), stereotypes (flapping hands
or pat), epileptic cases. Karyotype is the 46 XX or XY, 15q-. Usually the syndrome is
caused by a spontaneous chromosomal defect, when there is no large adjacent area of 3-4
million base pairs of DNA in the q11-q13 of the chromosome 15th.
According to the results of several independent researches, the cause of Angelman
syndrome may be a mutation in the gene UBE3A. The product of this gene is enzyme’s
component of a complex system of protein degradation.
In the clinical case there is the history of a boy with a clinical diagnosis: the
myoclonic status with non-progressive encephalopathy on the background of chromosomal
pathology, Angelman’s syndrome. There was an organic CNS lesion, atonic - astatic
syndrome, rough delay of mental and speech development, GMFCS IV level.
In this case, one can see all the features of Angelman’s syndrome; to follow how
started and changed epileptic cases and EEG picture; the efficiency of the therapy.
Prognosis depends on the level of injury of 15th chromosome. So people who have
only a mutation of a gene are able to serve themselves and communicate, while others
having a rough chromosomal pathology are not able to talk and even walk. Quality of life
is associated with severity of disease. Longevity is average. Such patients need special care
of relatives. Most often, these children are directed to special schools, where they can not
only learn, but also adapt to the society.
FEATURES OF THE EAR STRUCTURE OF ASMA STUDENTS OF 1990-1991
YEARS OF BIRTH
Dyachuk S., Talpe V. - the 1st year students
Scientific leaders- A.E. Pavlova, O.I. Katina
While conducting the study, we described the floor of the auricle in size, position,
protruding and shape. In size it can be: small, medium or large. The shape can be: round,
oval, rectangular, square and triangular. Protruding may be: a) general - when the entire
free edge of the ear is distant from the head; b) lower - farthest lobule; c) the top - the curl
is furthest from the head. The lack of protruding - when ears are pressed to the head.
We examined 70 first-year students. Among them there were 42 female and 28 male.
In female students:
a) the average length was 32 physiological case s- 6 cm, 6 cases- 5.5 cm, and in 4
cases it was 7 cm.
b) the average physiological width in 4 cases was- 4 cm, in 32 cases - 3.5 cm, in 6
cases - 3.0
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In male students: the average physiological length in15 cases were - 6.7 cm, in 10
cases - 10.0, in 3 cases - 7 cm.
According to the examination both in female and male students predominates:
- the oval form of the floor of the auricle;
- the middle size of the ear;
- the upper protruding.
RUSSIAN PHILOSOPHY
Dyachuk S. – the 1st year student
Scientific leaders – Cand.Hist.Sc. V.A. Pushkarev, O.I. Katina
Russian philosophy – is a phenomenon of world philosophy. Its singularity lies in
the fact that Russian philosophy developed entirely autonomously, independently,
irrespective of the European and world philosophy, and was not under the influence of
Western philosophy. At the same time Russian philosophy is distinguished by the depth,
versatility, sometimes incomprehensible to the West.
Characteristic features of Russian philosophy are:
- a strong exposure to religious influence, especially Orthodoxy;
-large role of morality issues;
- widespread among the masses, understandability to the common people;
- integrity.
Stages of Russian philosophy:
• The period of establishment of Old Russian philosophy in Russia.
• The philosophy of the period of the Mongol-Tatar yoke, origin, formation and
development of the centralized Russian state.
• Philosophy of the XVIII century.
• Philosophy of the XIX century.
• Russian and Soviet philosophy of the XX century.
Russian philosophy of the XVIII century includes two major stages in its
development:
• The philosophy of the reforms of Peter the Great.
• Materialist philosophy mid XVIII century
The first direction concerns the creativity of F. Prokopovich, V. Tatishchev, A.
Kantemirova. Based on the direction of their philosophy was a socio-political:
- Questions of Monarchy.
- Imperial power, its divinity and inviolability.
- Emperor’s rights (penalty, mercy).
- War and peace.
The philosophy of the direction was also engaged in other issues - knowledge, moral
values.
The main representatives of the materialist trend were M.V. Lomonosov, A.N.
Radishchev.
M.V. Lomonosov (1711-1765) was a supporter of the philosophy of mechanistic
materialism. He found the materialist tradition in Russian philosophy. Also the theory of
the structure of matter has been suggested by Lomonosov. According to it all the objects
around and the whole matter consists of tiny particles, i.e. atoms - monads material.
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A.N. Radishchev (1749-1802) paid much attention to the social and political
philosophy. Its credo – was the fight against the autocracy for democracy, legal and
spiritual freedom.
THE ANALYSIS OF A MATERNAL MORTALITY IN RUSSIA
Sakhratulaeva A.- the 5th year student
Scientific leaders - Doc.Med.Sc. L.N. Voit, O.I. Katina
Every day, about 830 women die from preventable reasons connected to pregnancy
and childbirth. 99% of all maternal deaths occur in developing countries.
Higher rates of a maternal mortality are observed among women living in rural areas
and among poorer communities. Girls of adolescence are at higher risk of developing
complications and death as a result of pregnancy than older women.
Due to qualified assistance before, during and after childbirth it is possible to save
the lives of women and newborn babies.
During the period 2005-2015, maternal mortality in the world decreased almost in
44%. In 2013 MD rate in Russia amounted 11.5 per 100,000 of live births. The structure
of main reasons of MD was: extragenital pathology – 21.9%; obstetric embolism - 15.8%;
edema, proteinuria, hypertension during pregnancy - 11.6%; bleeding during childbirth and
the postpartum period - 10.7%; bleeding due to the detachment and previa - 8.8%; sepsis
during childbirth and the postpartum period - 5.1%; uterine rupture - 3.7%; abortion
initiated outside the facility - 3.7%; medical abortion - 2.3%; complications of anesthesia
- 2.8%.
In 2014 on the territory of the Far East there were no cases of MD in the Amur and
Magadan Regions, and in Chukotka. In 2014 14 women died. Their death has been assigned
to category of MD.
The largest number of MD cases occurred in the Republic of Sakha (Yakutia) 42.86%; in the Primorsky region - 28.57%. The rest of cases of MD were in the Jewish
Autonomous Region - 7.14%; Kamchatka region - 7.14%; Khabarovsk Territory - 7.14%;
Sakhalin Region - 7.14%.
FLOOD IN SOUTHERN AUTONOMOUS REGIONS
FEDERATION IN 2016
Dombrova T. – the 2nd year student
Scientific leaders – Cand.Biol.Sc. L.A.Guba, O.I.Katina
OF
RUSSIAN
Krasnodar’s flood
In the 1st of June a heavy rain falls on the capital of Cuban. Lesser then for two hours
the roads becomes like rivers. Many houses and allotments suffered because of massive
volume of water. All emergency services and squads of volunteers participated in the
elimination of this situation. Among other things, in the center of Krasnodar 17 year old
teen took a heavy electrical damage. Ambulance doctors could not save his life.
Flood in the Kurgan region
From 18s of April to 1st of May the Kurgan region was under a heavy flood. As the
result 970 garden allotments as well as dozens of local areas were damaged. According the
data, the water level in the Tobol River was 7 meters and 89 centimeters. There were no
casualties. Data on the amount of damage is registered.
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AIDS IN THE RUSSIAN FEDERATION
Golumbievskaya E., Saryglar Ch., Urmancheeva V. – the 2nd year students
Scientific leaders – Cand.Biol.Sc. L.A. Guba, O.I. Katina
Acquired Immune Deficiency Syndrome – is a disease affecting the body's defense
system against infections.
Even the most minor infections insignificant for a healthy organism can lead to
serious consequences in AIDS patients. AIDS is caused by the human immunodeficiency
virus (HIV) that infects CD4-lymphocytes (cells that destroy infectious agents and
pathogens). By reducing the number of CD4-lymphocytes there is a malfunction of the
immune system. And definite infectious processes and malignant tumors begin to develop
in a patient. In HIV infection the number of CD4-lymphocytes in the blood is no more than
200. This state is called AIDS. The effectiveness of the immune system is decreased. It
may take about 10 years from the time of HIV infection to AIDS. Expanded AIDS stage is
regarded as incurable and fatal. Patients die on average in 5 years after ascertaining the
expanded AIDS. HIV can be detected by a blood test for antibodies to the virus. HIV
infection immediately after analysis may give false results as it takes on average from 6 to
12 weeks to generate antibodies. Sometimes a positive HIV test result can be obtained only
in 6 months after infection. Treatment of HIV and AIDS does not yet exist, but there are
many drugs that slow down the destruction of the immune system and can thus significantly
extend the lives of HIV-infected.
The biological substrates of human, through which the infection is possible: blood,
sperm and pre ejaculate, vaginal and cervical secretions, maternal breast milk.
One of the most important ways of prevention - is to have sex with only one partner;
have no contact with prostitutes, casual acquaintances, drug addicts using intravenous
needles; have the group contacts. Use condoms to protect against HIV. Use only your own
hypodermic needles, toothbrushes, razors. Insist on using only sterile disposable
instruments during surgery (including dental), acupuncture, tattooing, or piercing. If you
are supposed to have an extensive operation, pre-negotiate the possibility of
autotransfusion (blood transfusions for subsequent transfusion to himself).
The total number of Russians infected with HIV registered in the Russian Federation
in December 31, 2015 reached 1,006,388 people. Among them 212 579 HIV-positive died
due to various reasons.
Over the entire period of observation in the Russian Federation since 1985, it was
revealed 27579 HIV-positive foreign nationals, including 3567 - for the 2015. The
incidence rate in 2015 was 63.6 per 100 thousand of population.
In 2015, in terms of morbidity in the Russian Federation the leading regions were:
the Kemerovo region (registered 234.5 new HIV cases per 100 thousand people.),
Sverdlovsk (183.6), Tomsk (155.1), Novosibirsk (145.7 ), the Chelyabinsk (140.0) region,
the Altai Territory (132.7), Perm (123.6), Samara (121.2), the Irkutsk (118.9) regions, the
Khanty-Mansi Autonomous Region (114.9 ), the Krasnoyarsk region (114.8), Kurgan
(108.3), Tyumen (106.6), Ulyanovsk (97.2), Orenburg (96.9), Omsk (87.7), Leningrad
(80.1 ), Nizhny Novgorod (72.9) area. Cases of HIV infections have been registered in all
the regions of Russia.
In the Russian Federation in 2015 among HIV-infected people men are still
dominated (63.0%). Most of them were infected through drug use. By the end of 2015,
there were more than 372 thousand HIV-infected women. In most cases they were infected
through sexual contact with men. In 2015, HIV infection was detected mainly among
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Russians aged 30-40 years. The proportion of HIV infections in the age group 20-30 years
decreased from 64% in 2001-2004 years to 26.2% in 2015.
FIRES IN THE REPUBLIC OF TYVA IN 2013-2016
Oorzhak Y., Khovalyg S., Many-Khaya S., Bexe A. – the 2nd year students
Scientific leaders – Cand.Biol.Sc. L.A.Guba, O.I.Katina
In 2013 there were 11 active forest fires on a total area of 841 hectare. Among them:
• Kaa-Khem coal district - 4;
• Barun-Khemchik district - 3;
• Piy-Khem coal district - 4.
In 2014 11 forest fires appeared on a total area of 1028 ha. They were:
• Tes-Khem coal district - 3;
• Chedi-Khol district – 5;
• Dzun-Khemchik district - 3.
In 2015 20 forest fires were registered on a total area of 43.1 ha. Among them:
• Todzhu district - 10;
• Tere-Khol district-5;
• Tandeski district - 5.
In 2016 2 there were 2 forest fires on a total area of 17.5 hectares:
• Sut-Khol district - 1;
• Todzhu district - 1.
The causes of fires are human error and natural disasters.
FACIAL PROPORTIONS OF PEOPLE FROM 16-25 YEARS
Molokin D., Kurbanova S., Nikitina A. – the 2nd year students
Scientific leaders – Cand.Med.Sc. S.S. Seliverstov, O.I. Katina
The man's face can be divided into three parts. The first part is from the hairline to
the eyebrows. The second part is from the eyebrows to the base of the nose. The third part
is from the base of the nose to the chin. Perfectly balanced face has almost equal values of
these segments.
The nose
The nose is the most vivid distinctive feature of Europeoids. In people of this origin
nose is usually intensely favored on a face. It has a high base, bridge and pinned wings.
Asian type of nose has a small size, low bridge of the nose and almost does not
protrude. A typical Asian nose is flat, with projecting wings, which are directly integrated
with the tip of the nose. Asian nostrils (and African) type can be seen in front, while at the
Europeoids - only on the sides or not visible.
Humpback "broken" profile.
The hook: the tip is very low, like in an old man.
Eagle: shaped like a beak. Actually it has a more or less pronounced curvature.
Rome: a small hump-like aquiline nose.
Greek: it goes straight from the forehead, without basins.
Buttons: round and small. It has an upturned tip, but the nostrils cannot be seen. This
form is common to all children.
Perked: unlike aquiline nose, its nose bridge is concaved inside.
Snub: short and upturned nose. Common in Asians.
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"Funnel": characteristic for the Africans, but not for everyone!
Forehead
In the aesthetically proportionate face forehead and eyebrows occupy the top third.
Width of forehead is usually equal to half of its height. Forehead can be divided into
two parts: upper and lower. The lower part corresponds to the supraorbital region and
glabella area (the glabella). Bone basis of the bottom of the forehead affects the aesthetics
of the eyebrows, the upper eyelid and the root of the nose, because of the direct structural
support. Its shape is changed with the development of the frontal sinus, angularity and
stronger protrude forward in men.
The upper part of the forehead is located above the supraorbital region and consists
of a small vertical and transverse convexity. Tangible to the touch and often visible to the
eye edge of the temporal fossa is a lateral boundary of the forehead.
Eyes
The almond-shaped eyes are characterized by elevated outer area.
In gated eye the skin hides the natural shape of the eyelid. These eyes can be in a
person at birth, and may appear with age.
With deep-set eyes, the upper eyelid is hidden in the shadow because the fold of the
eyelid is quite deep.
Round eyes seem to be larger because of the curved lower eyelid.
Sleepy eyes are called so because of the curved shape of the upper eyelid.
The last type of the eye is when the movable lid is lowered down to the outer corner
of the eye.
Others, namely the ethnic types of eye, require more careful consideration.
Asian type
The easiest way to observe this type of eyes is on epicanthus. This is the upper eyelid
fold running from the nasal septum and overlying the inner corner of the eye. As a result,
the inner corner looks lower than it actually is, and the eye is like a slight slope. There is
variability in the way how much the inner corner is hidden and as a fold on the outside
corner is expressed. It is also important to note that even when the eyes are closed, their
inner corners are downwards.
There are two types of Asian eye. One is known as "double eyelid" when the lid has
a shape similar to the eyes of the Western type. Another type - is a "single eyelid". In this
eye there are no folds on the movable eyelid.
HEALTH OF INFANTS BORN FROM SMOKERS MOTHERS WITH CHRONIC
BRONCHOPULMONARY PATHOLOGY
Kanash T., Sakhratulaeva A., Zubkova M. - the 5th year students
Scientific leaders - Cand.Med.Sc. O.B. Prihodko, O.I. Katina
According to statistics over 24% of smokers among women are older than 15 years.
They have more intense negative effects of tobacco consumption than men, especially in
connection with the development of chronic obstructive pulmonary disease. Tobacco is the
basis of many respiratory diseases: chronic obstructive pulmonary disease, lung cancer, a
factor of bronchopulmonary pathology worsening. Smoking during pregnancy has adverse
effects on a fetus.
In Russia, there are 52-55% of smokers among pregnant women, and there are 2025% of those smoking during the whole period of pregnancy.
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The effect of chronic nicotine intoxication in pregnant women on exacerbation of a
disease is proved. In pregnant smokers gestational complications and fetal diseases are
often observed.
Our patients are 26 pregnant women with asthma.
68 pregnant women are with unobstructed HB, among them:
- 38 pregnant women with chronic nicotine intoxication;
- 30 non-smoking pregnant women;
- 30 healthy pregnant women.
A clear link between smoking and frequency of exacerbations of chronic bronchitis
and asthma with the development of gestational complications with the pathology of a fetus
was detected. So, smoking cessation is an important therapeutic and preventive measure.
It promotes both clinical improvement of chronic bronchitis and the reduction of the
incidence of gestational and perinatal complications.
GAS EXPLOSIONS IN RUSSIA
Vasiliev Y., Kherel Ch., MaliShewski D. – the 2nd year students
Scientific leaders – Cand.Biol.Sc. L.A.Guba, O.I. Katina
According to the JSC "Rosgazifikatsiya", annually there are about 230 different
incidents associated with the use of gas in the residential sector. On average, 130 people
die (80% as a result of poisoning with carbon oxide, 20% in the explosions of gas-air
mixture and fires).
To achieve the lower explosive limit with an extinguished torch of average size
about five hours (large 2.5) is enough. An explosive composite near the fireless torch can
be formed much earlier (10-15 minutes) that will also result in explosion, but of less power.
For the explosion of gas and air composite a source of fire is required. It can occur from a
spark when turning on the electricity or the water heater where a "fuse" is constantly on.
Definitely one can blame the careless inhabitants among them there are a lot of older
people, and childish pranks can cause prolonged gas leak. However, the main problem is
that in most of our apartments there are steam gas rangette. They don't have automatic gas
cut – off ("stop-gas") in its leakage. Modern rangette is equipped with another system and
automatic gas kindling. In the latest models of gas rangette there is a protection from
children that disables the stove during the absence of adults at home. But such models fitted
with universal protection are quite expensive. In any case, operating gas equipment must
not be left without supervision of the person.
The danger of gas explosion increases significantly for single persons, elderly with
elements of dementia. In such a situation it is advisable to install a kitchen induction
equipment that is significantly safer and more economical.
Unfortunately, there is no legal basis for the mass replacement of technically
obsolete plates in explosion-proof. It is sad that the population is not informed about the
need to acquire modern gas equipment, as well as monitoring the health of gas equipment
(for safety regulations it is necessary to control every four years). If there were the mass
installation of rangette with "stop gas", they would be quite available to the public at a
price. It should also be noted that gas rangettes have a low efficiency: for gas burners, it is
60%, and the oven one - only 6%. In economy of gas the efficiency is much higher (80%).
Replacement of gas rangette on electric one, especially induction, can give a great effect
both on the economy as fuel, and lower explosive limits (efficiency induction hobs 90%).
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And the energy of gas explosion is significant: one kilogram of gas is equal to the
explosion of 8-9 kg of TNT. Sad statistics: at 100 explosions, buildings are ruined and
people die in 90-95 cases. Surprisingly, the installation of plastic windows is also fraught
with negative consequences. Since the destructive properties of the explosion depend on
the strength of the windows, the destruction in the house will be more with plastic windows.
High strength of modern windows with triple glazing leads to a significant increase of
excess pressure that promotes the destruction of the walls of the building.
Another problem is that natural gas itself and the soil under the houses often contain
radioactive radon gas. The installation of plastic windows requires supply and exhaust
ventilation in the house to prevent increase in the concentration of radon in the apartment
(especially in the first and second floors of the house).
Conclusions:
1. to stop the installation of explosive gas rangette in new buildings;
2. gradually change the old gas rangette for explosion-proof;
3. to inform the public about defects of the old gas rangette;
4. to provide financial assistance in the acquisition of explosion-proof plates of those
residents who belong to the category of high risk of explosion (elderly, disabled, etc.).
5. to explain the rules for the safety of gas appliances;
6. to state those residents who are unable to use gas safely due to various reasons;
7. to develop criteria for the ban on the use of gas equipment in residential
construction (floors, region, etc.);
8. frame with glass should be made in the form of hinged windows;
9. to equip the building with exhaust ventilation when there is a mass installation of
plastic windows;
10. to install in the apartments demodectic and gasoducto, especially on the first
floor;
11.to carry out the repair of house gas networks and equipment;
12. to provide preferential loans when all the apartments of the house have explosion
proof gas equipment.
EVALUATION OF PHYSICAL DEVELOPMENT OF MALE AND FEMALE
FIRST YEAR STUDENTS OF THE MEDICAL ACADEMY BY
ANTHROPOMETRIC DATA
Bukhanovskaya Y. – the 2nd year student
Scientific leaders – L.G. Zherepa, O.I. Katina
The catastrophic decline in the quality and level of health of the population as a
whole and especially in children and adolescents - is an undeniable fact that causes concern
among experts. A person, of course – is the absolute value of the society and his health - is
a guarantee of the harmonious development of the society.
Health – is a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity.
One of the indicators of health is physical development. Physical development - is
a process of quantitative and qualitative changes in all indicators (body height, body
weight, circumference of the various parts of the body).
Total picture about the physical development is obtained due to three basic
dimensions: height, weight, circumference of the chest. Having received the
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anthropometric data, it is possible to estimate the correspondence of analyzed parameters
to age norms of harmonious development and to identify the type of constitution.
Identification of deviations in parameters of physical development may be risk
factors or symptoms of certain diseases. Therefore, the ability to assess the obtained results
of the measurements properly may contribute the education of stance on a healthier
lifestyle.
Some factors may not only disrupt the sequence of development, but also cause
irreversible changes. These include: external - adverse intrauterine development, social
conditions, poor nutrition, lack of exercise, bad habits, work and rest, the environmental
factor; domestic - family history, the presence of disease.
When assessing the anthropometric data and physical development of 90 girls and
40 boys of the first year students of the Medical Academy, a tendency to decreased growth
among girls and boys was found. And the decrease in the level of development of
subcutaneous adipose tissue among girls and, on the contrary, the increase of the level of
fat among boys was noted. It may indicate a tendency to overweight and obesity.
DIFFERENCE OF HUMAN AND ANTHROPOIDS BONES
Ivchenko A., Martynova K – the 1st year students
Scientific leaders – A.E. Pavlova, O.I. Katina
There are a number of significant differences of human limbs from the anthropoids.
In the upper limbs the humerus is relatively enlarged and the bones of the forearm and hand
are shortened. An intense torsion of humerus diaphysis is characteristics of human. It
compensates the bend of the head of the humerus medially, respectively the position of the
scapula. In a hand there is more intense development of 1 and 2 rays. Thumb and forefinger
play a particularly important role in the subtle movements of the hand of the human.
Human lower limbs feature with powerful development, great length, straight in the
knee joints. Their peculiarities are due the adaptation to the vertical position of the body.
Human pelvis is wider and shorter than in anthropoids. Pelvis is bulker. Its transversal size
prevails over the sagittal one, while in monkeys the correlation is inversed. In the course
of anthropogenesis the rotation of the pelvis axis occurred. Sacrum leaned back and iliac
wings moved forward changing the position of the pelvis towards the spine. Human pelvis
has pronounced sexual differences that are almost imperceptible in animals.
Human femur is the longest bone in the skeleton. It accounts for nearly a quarter of
the body length. Individual differences of body growth depend mostly on the femur. The
bend of the femur diaphysis and its distal end inward as well as outward bend of the tibia
are characteristic. It plays an important role in the mechanism of walking.
Human foot is a dedicated support structure. It is the most specific part of human
limbs. Unlike monkeys, in humans it has powerfully developed proximal part made by
calcaneus and talus. At the same time, the toes are shortened. In the process of hominization
there was the reinforcement of the 1 ray and the reduction of the lateral toes, especially the
little finger where the fusion of middle and distal phalanges is often observed. Along with
the longitudinal vault the foot acquired the cross vault. The human foot is pronated and
generally represents the twisted plate. Behind it leans the calcanean tuber and in front - on
the heads of metatarsal bones.
Architecture of cancellous foot is determined that from the lower end of the tibia
there are two systems of tension lines extending through the talus. One of them goes to the
calcaneal tuber, the other one goes to the concavity of the foot to the head of the metatarsal
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bones. These trajectories are perpendicular to the articular surfaces and are not broken by
the joints. There are intersecting systems of bone beams in the calcaneus. They extend in
the back and plantar directions. The powerful ligament apparatus, especially the long
plantar ligament and the plantar aponeurosis plays a big role in the strengthening of the
arch of foot. The last one connects both ends of the foot and keeps them from disperse.
MYOCARDIAL INFARCTION
Vasiliev D., Barannikov S. – the 3rd year students
Scientific leaders – Cand. Med. Sc. S.S. Perfilieva, O.I. Katina
Myocardial infarction is ischemic necrosis of cardiac muscle. Therefore clinically,
in addition to changes in the electrocardiogram, it is characterized by enzymemia. Usually,
this is ischemic (white) infarction with hemorrhagic halo.
Myocardial infarction is often localized in the apex, anterior and lateral walls of the
left ventricle and anterior parts of interventricular septum. A heart attack rarely occurs in
the posterior wall of the left ventricle and posterior parts of interventricular septum. When
the main trunk of the left coronary artery and both of its branches are exposed to
atherosclerotic occlusion, a gross myocardial infarction develops.
Myocardial infarction can affect the various parts of the cardiac muscle so there are
subendocardial, subepicardial, intramural and through all thickness of the heart muscle transmural infarctions.
The course of myocardial infarction has two stages: necrotic and stage of scarring.
At histological examination in necrotic stage the area of infarction is a necrotizing
tissue where "islands" of unaltered myocardium are preserved perivascularly. The area of
necrosis is separated from the surviving myocardium by area of plethora and leukocyte
infiltration (demarcating inflammation). This stage is characterized not only by necrotic
changes in the focus of infarction, but also the deep vascular and metabolic disorders out
of this center. They are characterized by foci of uneven blood supply, hemorrhages,
disappearance of glycogen in cardiomyocytes, the appearance lipids in them, destruction
of mitochondria and sarcoplasmic network, necrosis of individual muscle cells. Vascular
disorders also appear outside the heart, for example in the brain where irregular hyperemia
may be deteced, stasis in capillaries and diapedetic hemorrhages.
Stage of scarring (organization) of a heart attack starts basically when macrophages
and young cells of fibroblastic series arrive to change on leukocytes. Macrophages
participate in the resorption of necrotic masses. Lipids and products of tissue detritus
appear in their cytoplasm. Fibroblasts, having a high enzymatic activity, are involved in
fibrillogenesis. The organization of infarction occurs as from a zone of demarcation, so as
from the "islands" of surviving tissue in the area of necrosis. At first the newly formed
connective tissue is loose like a granulated tissue. Then it matures into scar tissue where
islands of hypertrophied muscle fibers are seen around the blood vessels. In the pericardial
cavity adhesions appear in the outcome of fibrinous pericarditis. Vessels anastomosing
with the extracardiac collaterals are often formed in them. It helps to improve the blood
supply to the myocardium.
Thus, at the organization of a heart attack a dense cicatrix is formed on its place. In
such cases the postinfarction large-focal cardiosclerosis is meant. The surviving
myocardium, especially along the periphery of the rumen, undergoes regenerative
hypertrophy.
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THYMUS AND ITS ROLE IN THE REGULATION OF LYMPHOPOIESIS
Shusharina V. – the 2nd year student
Scientific leaders – V.S. Kozlova, O.I. Katina
Thymus (thymus gland) — is an organ of human lymphopoiesis in which the
maturation, differentiation and immunological "training" of the T cells of the immune
system occur.
The lymphocytes are derived from blood stem cells migrating to the thymus from
the liver in the early stages of fetal development.
In the lobule tissue the medulla and cortical substance are distinguished. There are
pillar cells in the cortical substance: form the "framework" of the tissue and hemato-thymus
barrier; stellate cells: secrete soluble thymus hormones — thymopoietin, thymosin and
other hormones that regulate the processes of growth, maturation and differentiation of Tcells and the functional activity of mature cells of the immune system; "nurse"-cells: have
intussusceptions where the lymphocytes develop; hematopoietic precursor cells: lymphoid
series: maturing T-lymphocytes; macrophage series: typical macrophages, dendritic cells
and interdigitate.
Directly under the capsule the dividing T-lymphoblasts are dominated in the cellular
composition. Deeper there are maturing T-lymphocytes, gradually migrating to the brain
substance. In their maturation process the rearrangeable of genes and the formation of the
gene encoding the TCR (T-cell receptor) occur. Then they undergo the positive selection:
interacting with epithelial cells the "functionally fit" lymphocytes are selected. They are
capable to interact with HLA. While the development, the lymphocyte can differentiate in
a helper or a killer. The next stage, the negative selection of lymphocytes, occurs at the
boundary with the brain substance. Interdigitale and dendritic cells — the cells of
monocytic origin — select lymphocytes capable to interact with antigens of their organism,
and trigger the apoptosis. In the medulla mainly ripened T-lymphocytes are contained.
From here they migrate into the venule bloodstream with increased endothelium and settle
on the body.
Age involution of the thymus. The thymus gland finally progresses to 3 years of life.
Up to 20 years the thymus is in a stable position. Then it undergoes the age-related
involution. Thus, the connective tissue of capsule and trabeculae grow and adipose tissue
develops. Simultaneously, T-lymphocytes disappear from the cortex and the medulla of
the lobules of the thymus. As a result, the thymus turns into the adipose body.
Temporary involution of the thymus occurs in injury, illness, intoxication, stress. A
large amount of glucocorticoids is produced in the adrenal cortex. Under their influence
the cytolysis of lymphocytes or their uptake by macrophages occurs. As a result the cortical
substance of the lobules of the thymus is as bright as a brain. Temporary involution
continues until the illness or stress last. After that, the state of the cortex and the medulla
returns to normal.
EMERGENCY SITUATIONS ON WATER TRANSPORT IN RUSSIA FOR THE
LAST SIX YEARS
Soboleva A., Kudryashova D. – the 2nd year students
Scientific leaders – Cand.Biol. Sc. L.A.Guba, O.I.Katina
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2011
18 Dec. 2011 the drilling platform “Kola” has turned over in the Okhotsk Sea. Only
14 of 67 people being on board were saved.
July 10, 2001 the two-deck diesel-electric “Bulgaria” sank. The crash occurred
during a storm in the Kuibyshev headwaters in Tatarstan, three kilometers from the shore.
At the moment there were 201 people. 122 of them died.
2012
1 June, 2012 in the Saratov region, in the waters of the Volgograd reservoir, 8 people
on a private boat «Kazanka - M» clashed with a floating tree and overturned. 3 people died,
including one child.
2013
17August, in the Omsk region on the Irtysh river passenger ship «Polesye-8»
clashed with a barge. According to preliminary data, the ship was holed. There were 56
passengers and four crew members on board. As a result 35 people were injured and four
people died.
2014
4 Jun, 2014 in the river port of Yakutsk, in the water of the Lena River a private
boat “Volga” clashed with a timber. There were 14 people – the captain and 13 passengers.
One person died.
2015
On the night of 2 April the big trawler “Far East” sank in the Okhotsk Sea in 300
kilometers from Magadan. 132 fishermen (including 54 foreigners) were on board at the
moment. Rescuers pulled from the icy water 119 people. 57 of them died, others were
seriously frostbite, and 12 people reported missing.
2016
The wreck of two boats on Lake Sumozero in Karelia during the storm took the lives
of 11 children. There were 26 people (two adults and others were children). 10 children
died, 13 people were rescued. Two more were missing.
THE SYNDROME OF THE SUPERIOR MESENTERIC ARTERY
Vasylev D., Azadov S. – the 3rd year students
Scientific leaders - N.V. Korshunova, O.I. Katina
The syndrome of the superior mesenteric artery - is an external compression of the
duodenum in the position of a child on his back as a result of a rapid weight loss. It is
believed that the cause of the syndrome is the reduction of fat in the mesentery and the
compression of the duodenum between the superior mesenteric artery (anterior) and the
aorta (posterior).
The loss of fat around the second and third parts of the duodenum is considered to
be the possible cause. It leads to the press of these parts to the spine in the supine position.
A classic example would be a teenager who has vomiting occuring after applying
the plaster corset during orthopedic surgery. Other associated factors include anorexia,
prolonged bed rest, weight loss, abdominal surgery, pronounced lumbar lordosis.
Diagnosis is based on X-ray data - characteristic "break" of the duodenum to the right of
the midline. Obstruction of the duodenum may be accompanied by dilatation of the
proximal part of it, or stomach.
Treatment of this acute condition is to eliminate the obstructions and improve the
diet to restore the normal anatomic correlation of the duodenum and surrounding
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structures. Changing of the position of the body (the patient turning on his side or abdomen)
promotes the shifts of the duodenum to the side and the possibility of the resumption of
food intake.
In some cases, it is advisable to administer prokinetics - metoclopramide or
cisapride. If the change in body position does not normalize the patient's condition,
nasojejunal tube is set and feeding begins. Some patients require the total parenteral
nutrition for the recovery of fat or surgery.
DEPENDENCE OF HAND SIZES ON THE PARAMETERS OF GROWTH
AMONG MALE SRUDENTS OF ASMA 1991-1992 YEARS OF BIRTH
Varvarin G. – the 1st year student
Scientific leaders – A.E. Pavlova, O.I. Katina
The length of hands of 24 men was made to obtain the results of the research.
Height:
160-169 cm - in seven men;
170-179 cm - in ten men;
180-194 cm – in seven men.
Average hand's length in men with growth:
160-169 cm – 17 cm;
170-179 cm – 19 cm;
180-194 cm – 20 cm.
As a result, while studying these parameters we learned to use height meter and
tape- measure. We realized that the anthropometric data have a great clinic value
as deviation from the average parameters may indicate some diseases.
VIBRATION DISEASE PREVENTION
Hertek S. – the 3rd year student
Scientific leaders - E.A. Litovchenko, Doc.Med.Sc. N.V. Corshunova, O.I. Katina
Vibration disease - is an occupational disease that occurs as a result of long-term
effects on the body of such physical phenomena as vibration.
The basis for preventing the vibration disease is maximum possible reduction of
vibration effect on the body. This is the introduction of remote control over the vibration
processes, the improvement of hand tools by reducing the vibration at the source of its
formation and through its path, the installation of shock absorbers for machines that
dampen the vibration. It is necessary to follow hygiene regulations at work and make sure
that the vibration level does not exceed the maximum permissible level.
Work with vibrating equipment usually must be carried out in rooms with
temperatures at least 16 ° C at 40-60% humidity. If the organization of such conditions is
impossible (outdoors or underground work), special heated rooms must be provided for the
periodic heating with the air temperature at least 22 ° C. It is also important to use personal
protective equipment, namely gloves with palm pad of elastic material and special shoes
with thick flexible soles.
The correct organization of work is of great importance in the prevention of
occupational vibration disease. Time of work with vibrating tools should be strictly limited
in intervals. It is necessary to make a 10-minute break after every hour of operation and
lunch break is mandatory. Also two breaks for complex production gymnastics and
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physiotherapy (20 min in 2 hours after the beginning of the shift and 30 minutes in 2 hours
after the lunch break) are necessary. Duration of a single continuous vibration should not
exceed 15-20 min, the total time of exposure to vibration - 2/3 of the total working time.
After the work physiotherapy is recommended: showering (fan or Charcot-type), a warm
bath for the hands and the massage of the upper extremities. In order to prevent the disease
vibration the course of ultraviolet irradiation in suberythermal doses is carried out. Also
the fortification, physical hardening, good nutrition, organization of active recreation is
very important. Preventive treatment is recommended (1-2 times per year).
To work with vibrating machinery and equipment is allowed to persons over 18
years of ages who received the appropriate qualifications, passed a minimum of technical
rules security and are medically available. Periodic medical examinations are carried out
once a year with the participation of the therapist, neurologist, and otolaryngologist. People
with Raynaud's syndrome, diseases of the central and peripheral nervous system,
cardiovascular diseases, chronic diseases of the musculoskeletal system, gastrointestinal
tract, lesions of the vestibular and hearing aids are not allowed to a work related to exposure
of vibration.
THE CAUSATIVE AGENTS OF CATHETER-RELATED INFECTIONS
Goncharova А., Alkhimova N. – the 3rd year students
Scientific leaders - A. V. Prokopenko, O.I. Katina
There is great number of operations performed every day. Most of the operations
require the necessity to keep in body cavities drainages and catheters for a long time. But
they being in contact with the external environment become infected. All catheters can be
colonized by bacteria as a result of destruction of the skin in the injection area,
contamination during insertion or maintenance of catheters and bacteremia in patients with
distant
foci
of
infection.
Patients receiving parenteral nutrition are more sensitive as a high concentration of glucose
promotes the growth of microorganisms.
Most often in catheter – associated infections are:
1. Coagulase-negative staphylococci (S. epidermidis, S. Saprophyticus) – 3449.1%;
2. Staphylococcus aureus is 11.9-17%. Staphylococcal infections are acute bacterial
anthroponosis diseases with different mechanisms of transmission, characterized by a
polymorphic clinical picture. Among them coagulase-negative staphylococci (S.
epidermidis, S. Saprophyticus) and coagulasepositive (S.aureus) cause catheter –
associated infections. Staphylococci – are fixed gram-positive cocci, the cell diameter is
from 0.6 to 1.2 microns. S.aureus spreads by air-droplets and by contact-household. It is
pathogenic for the organism. Due to coagulase activity there is an early blockade of
lymphatic vessels that leads to limiting the spread of infection and clinically is manifested
by the appearance of the infiltrative necrotic and suppurative inflammation. Epidermal
Staphylococcus is an opportunistic. It inhabits all mucous membranes or any area of the
skin. The vast majority of infections occur in weakened people. Through vascular and
urethral catheters it pierces the body and can cause blood poisoning and endocarditis. S.
aureus is an opportunistic microorganism. It often causes inflammation of the bladder
(sometimes kidney) in women.
3. Enterococcus spp.( Enterococcus faecalis) – 5.9-6%. The genus Enterococcus
belongs to the facultative anaerobic asporogenous chemoorganotrophic gram-positive
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bacteria. These bacteria are consorbents of human intestines. They survive in the soil and
food products and multiply at room temperature. The spece E. Faecalis is of primary
importance in human pathology as it causes sepsis, inflamation of the urinary and digestive
pathways and organs, skin and subcutaneous tissue in a weakened organism. Strain E.
faecalis is antagonist for other pathogens.
4. Candida spp. (Candida Albicans, Candida Parapsilosis) – 7.2-9%. Fungi of the
genus Candida consist of oval budding yeast cells (4-8 µm), pseudohyphas and septate
hyphas. C. albicans forms chlamydospores. Incorrect prescription of antibiotics, immune
deficiencies, increased skin moisture, damage of the skin and mucous membranes facilitate
the development of candidosis. Candidiasis is often caused by C. albicans producing
proteases and integrirovanie molecules for adhesion to extracellular matrix proteins and
other virulence factors. Candida cause visceral candidiasis (candidiasis of the urinary
system), candidiasis of skin and nails, allergies to the antigens Candida.
5. Pseudomonas spp. (P. Aeruginosa) is 4.9-6%. These are gram-negative motile
aerobic microorganisms (0.5-0.6 x 1.5 microns) in the form of sticks with a flagellum
without a distinct capsule. P. aeruginosa grows better in a humid environment and can
accumulate in the hospital dust. The pathogenic effect of P. aeruginosa is implemented
using the complex of exoproducts: pigments, enzymes, toxins. Boric and formic acids,
potassium permanganate affect it destructively.
6. Enterobacteriaceae (Escherichia coli) is 1-2%. E. coli are gram-negative rods (26 microns), paraneoplasia, facultative anaerobic bacteria. Source of infection is sick people
or a carrier. It is pathogenic and highly virulent.
Diagnosis. In order to obtain material for microbiological examination of catheters
without removing them a special nylon brushes attached to the conductor were developed.
They allow to collect the bioenvelop from the inner surface of the catheter. As a shortcut
method it is also proposed to conduct the microscopy of blood samples stained by the gram
stain or acridine orange, obtained from the suspected catheter. The study of the precipitate
obtained during centrifugation of native blood is also possible.
Catheter colonization was defined as growth of less than 105 CFU/ml. Infection of
the catheter is determined with the growth of more than 105 CFU/ml without signs of
systemic infection and in case of negative results of blood culture. Cattery sepsis is defined
when the growth of 105 or more CFU/ml in a patient with positive results of blood culture,
signs of sepsis or both of these indicators. And this tube should be either removed or
replaced with a new one.
Treatment. When proven catheter infection, the treatment should continue from 7
to 15 days. In patients with impaired immunity or patients with sepsis it may take a longer
period. If within 48-72 hours the patient does not respond to the treatment, the catheter
should be removed and sent for inoculation. And scheme of antibiotic therapy should be
corrected.
Prevention. Hand washing or their treatment using products based on alcohol (the
2% solution of chlorhexidine gluconate) as before the catheter’s appliance so as during
manipulations with it are the most important measures that can significantly reduce the
spread of infection. Maximal amount of aseptic technique during catheterization is proved
to reduce the incidence of catheter-related infections significantly.
Conclusion. Recognition of the relevance of the problem, development of
organizational - methodological guidance and standards for cannulation and care of the
catheters, training of medical personnel on these issues will reduce the number of emerging
catheter-related infections.
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THE PLACENTA. A HEALTHY PLACENTA – A HEALTHY BABY
Subanov G. – the 2nd-year student
Scientific leader - PhD. D. A. Semenov
Placenta – a temporary female body. There is this body only during pregnancy and is
critical for the child and for mother. From the functioning of the placenta affects the
development and growth of the unborn child. When dividing the egg cells are formed,
providing a contact of the fetus with the maternal organism. And from the first minutes of
fertilization begins the formation of the placenta. Nutrients the fetus receives from the
tissues of the female body. Through the placenta establishes the exchange of nutrients
between the child and the mother. As needs change, growing organism the structure of the
body changes. The placenta reaches full maturity by the end of 35 weeks of pregnancy.
The main task of the placenta is providing the fetus with oxygen from maternal blood.
Through the placenta in the opposite direction of the transported carbon dioxide. Nutrients
required for development and fetal growth, delivered through the placenta. In addition,
waste products from the fetus also gets rid of through the placenta. It supports and provides
immunological protection of the fetus.
Pathology of the placenta today are quite common. The most common pathology of the
placenta: previa, abruption in pregnancy, low placentation, placental dense attachment of
the placenta accreta, early or late maturation of the placenta, the change of the lobed
structure, infectious inflammation, the change in the thickness of the placenta, placental
infarcts. Often a complete placenta previa. However, the uterine cavity is almost
completely blocked by the placenta. And partial placenta previa. The anomalies of placenta
eclipses last only a portion of the lumen of the internal OS.
The mechanical location of the placenta in the uterus almost completely depends on the
location of the uterine wall, in which is embedded blastocyst. The fact that the placenta is
born in this place and growing around him, increasing in size. Of course, this is a very
simplified explanation, but the fact remains — in order to further the placenta is situated
normally, the egg should implant in the upper half of the uterus. Exactly what usually
happens. But if the introduction of it into the uterine wall occurs in the lower half, the
developing placenta remains nothing, except to occupy the region of the internal OS. From
this it follows that the frequency of pre-lying placenta is affected, or changes in the uterine
wall, or the properties of the ovum. Anything that contributes to degenerative changes in
the uterine wall for example; abortion, inflammatory diseases, a large number of previous
pregnancies, old age, sickness with blood circulation in the pelvis, automatically raises the
risk of an incorrect implantation of the blastocyst.
THE HOT ISSUES IN THE DIFFERENTIAL DIAGNOSIS OF THE
BRONCHIAL ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
Makarova A., Borodin P. – the 6th year students
Scientific leaders – doct. of med. sc., ass. prof. Prikhodko O.B., cand. of med. sc.
Kostrova I.V.
Today there are about 300 million patients with bronchial asthma (BA) over the
world. The incidence of asthma in Russia is 2.2% (about 7 million people), while the
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mortality is quite significant - 28.6 per 100 000 people. That means that about 43
thousand people die of asthma each year in Russia.
Chronic obstructive pulmonary disease (COPD) ranks 4th place in the world in the
causes of death. According to official statistics, COPD diagnosed in 1% of Russians.
According to the first international epidemiological study of chronic respiratory diseases
in Russia, it is revealed that more than 15% of Russians have COPD symptoms. In spite
of this, experts are sure that the real incidence is even higher.
In recent years, the permanent debates of the problems of differential diagnosis of
bronchial asthma and chronic obstructive pulmonary disease are performed.
BA and COPD are two independent and the most common chronic diseases of the
respiratory system. Despite the definite differences between them in the mechanisms of
development, clinical manifestations, prevention principles and treatment, these two
diseases have some common features. That is the reason of the certain difficulties in the
practical work of even well-qualified physicians.
BA and COPD are common as they are based on a chronic inflammatory process
that determines the clinical picture. In BA, the inflammatory process is allergic and is
localized mainly in the airways, while there is a completely different situation in COPD.
In GOLD, inflammation in COPD is named as "abnormal inflammatory response" - an
abnormal inflammatory response to environmental factors aggression. The distinguishing
feature of COPD is the localization of inflammation. Just as in asthma the inflammation
is localized predominantly in the peripheral airways, but unlike BA is not limited and
extends to the interstitial tissue and the lung parenchyma, leading to the destruction of the
alveolar walls and the formation of pulmonary emphysema. This mechanism is a major
component in the formation of irreversible airflow obstruction. Another important feature
of COPD is a progressive nature of the disease, which is not typical for classical asthma.
In clinical features, BA is characterized by reversibility of waviness and respiratory
symptoms. In COPD, there is slow but steady increasing of the dyspnea, which is poorly
controlled by conventional bronchodilators.
Differential diagnosis of BA and COPD is based on the integration of the basic
clinical data, functional, and laboratory test results.
For patients with asthma there is a plenty of risk factors - allergens, causing the
development of the disease. As for COPD, the primary risk factor is smoking (90%). For
the majority of patients with asthma it seems probable to find genetic predisposition,
which is not typical in patients with COPD. At the same time, the BA may start in any
period of life of the patient, and COPD manifests in the second half of the life, due to the
accumulation of risk factor exposures for many years.
The analyzing of the clinical manifestations is the most significant component of
the diagnostics. Here are revealed well-defined and fundamental differences. Asthma
symptoms are characterized by undulation, the severity of the clinical manifestations and
their reversibility either spontaneously or after the treatment. The severity of the
condition in BA is not determined by the duration of the disease and can be serious at the
onset. After that, by taking the adequate therapy the condition may become better up to
the complete disappearance of the clinical symptoms. The severity of COPD increases
gradually with the age.
Functional differences between asthma and COPD are likewise considerable.
Changes in respiratory function are the distinctive features of these two diseases - wavelike symptoms are typical for BA and absent in COPD. Herewith, such functional
changes are progressive in COPD and lead to the patient disability.
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PRIMARY AND SECONDARY PREVENTION OF MYOCARDIAL
INFARCTION IN TRADITIONAL CHINESE MEDICINE
Borodin P. – the 6th year student
Scientific leader – cand. med. sc., ass. prof. Molchanova Ye. Ye.
Coronary heart disease (CHD) is the underlying disease of the cardiovascular
system. Myocgardial infarction (MI) as a consequence of CHD is the leading case of
mortality in most countries over the world including Russia. Atherosclerosis of the
coronary vessels is the predominant cause of CHD. Thus, special treatment and wellness
programs are required for the atherosclerosis prevention, and consequently, for the
prevention of myocardial infarction.
Among the standardized guidelines for the primary and secondary prevention of
MI are isolated medication and non-drug methods. Medication methods are: the regular
intaking of antihypertensive drugs, glucose control with hypoglycemic agents (Diabetes
mellitus), intaking of the antiplatelet agents (aspirin / clopidogrel), anticoagulants
(heparin), and statins (atorvastatin, rosuvastatin. Non-drug methods include quitting
smoking and moderate use of alcoholic drinks, diet correction, normalization of body
weight, increasing of physical activity, avoidance of emotional stress, regular monitoring
by the cardiologist.
Unfortunately, the treatment of CHD in Western medicine is not efficient enough.
On the other hand, the effectiveness of Traditional Chinese Medicine (TCM) is proved by
thousands of years of medical experience. Nowadays, the oriental therapies, such as
herbal medicine, acupuncture, energy healing massage and others, are successfully
practiced in many medical centers around the world. The benefits of TCM methods are
lack of drug intoxication, stimulation of the own adaptive capacity of the organism,
homeostasis normalization, the almost complete absence of contraindications, individual
approach for the each individual patient, simplicity and accessibility of the most methods
for implementing them directly by the patient. But, the patients who had MI in the past,
must be regularly consulted by the medical specialist and stay on dispensary observation.
The one way of the vitality massage is influence on the Heart meridian to correct
mental activity and to stimulate circulation. Massage is carried out by dynamic
stimulation of the proximal phalanx dorsum of the little finger for 1-3 minutes. Reducing
of pain indicates the restoration of the energy circulation in Heart meridian.
In TCM, patients are also prescribed for the sessions of hirudotherapy. Leeches
have antitrombomatic and antiplatelet effect, reducing the risk of MI.
Phytotherapy is one of the basic methods of therapy in TCM, which can be
effectively used to restore the functioning of the cardiovascular system. Tincture or fluid
extract of hawthorn is shown as an anti-arrhythmic and antispasmodic drug. The tincture
of ginseng or lemongrass, lemon balm mixture, valerian root and motherwort are shown
for stress resistance. Raspberry fruits, fruits and leaves of the sea buckthorn, daisy
flowers pharmacies, oats, grass seed, dandelion roots, etc. are well for the prevention of
atherosclerosis.
Breathing exercises are also used for the prevention of MI in TCM. Chinese
doctors recommend to perform it early in the morning, at the sunrise. In particular,
patient should stand facing east, relax, breathe shallowly and bring the chin to the chest,
hold breath. Legs should be slightly bent at the knees and the body should be lean
forward. Then abdomen should be tighten up as deep as possible to maintain and patient
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have to count from 1 up to 10 in his mind. Patient have to start with the greatest possible
numbers and add 1-2 seconds per day, bringing a breathing delay up to 30 seconds.
Secondary prevention of MI is to prevent the complications development and
recurrent MI, and is performed after the course of rehabilitation with the monitoring of a
cardiologist. Acupuncture performing is allowed no sooner than after 180 days of MI
development in the points of xin-shu (BL15), jue-yin-shu (BL14), nei-guan (PC6), tanzhong (RN17), xi-men (PC4) , tsu-san-li (ST36), sheng-tang (BL44), tun-li (HT5). Thin
needles and both "bu-fa" and "se-fa" techniques are used, needles delay is of 20-30
minutes.
Auriculotherapy is effective in combination with minor pressure in reflex points of
the heart, breast, brain (pituitary gland), small intestine and liver (thin needles, moderate
stimulation and needle delay of 20-30 minutes). Thermopuncture is used in the points of
tan-chung (RN17), ge-shu (BL17), sing-shu (BL15), tsu-san-li (ST36) (warming by
wormwood cigarette for 10-20 minutes per point, 1 time / day).
DISEASE OSGUT-SHLYATTER (OSTEOCHONDROPATHY OF TIBIAL
TUBEROSITY)
Lopatina E., Ondar S. – the 6th year students
Scientific leaders - Cand.Med.Sc. Dudarykov S.A., Kostina V.V.
Osgood- Shlyatter is called aseptic destruction of the tibial tubercle and its kernel,
which is caused by a chronic injury during their intensive growth of the skeleton. It usually
occurs in children and adolescents aged 10-18 years old. The causes of the disease are often
the following factors: direct trauma (fractures and dislocations of the patella or tibia, knee
joint damage); constant microtrauma of knee associated with contact sports. As a result of
overload, constant microtrauma of knees, as well as excessive patellar ligament tension
occurring during contractions of the quadriceps femoris muscle, there is a violation of the
blood supply in the area of the tibial tubercle. It is accompanied by minor bleeding, rupture
of patellar ligament fibers, aseptic inflammation in the bags, as well as changes in necrotic
nature of the tibial tubercle.
The first symptoms of the disease are not intensive pain in the knee during the
squat, going up and down the stairs, and when bending the knee. After considerable
physical loading pain intensifies, there is swelling of the knee, which smooths the tibial
tuberosity.
Crucial in the diagnosis of osteochondropathy tibial tubercle is a radiography of
the knee. On the radiograph in lateral projections there is observed characteristic
"proboscis" in the tibial tuberosity isolated small size bone fragments, in 1-3 amounts. The
picture is very diverse, reminiscent of crushing, or fissuring of curvature of the epiphyseal
bone.
Treatment is usually conservative, outpatient and is supervised by traumatologist,
surgeon or orthopedics. First of all, one must exclude physical load, and maximum comfort
of knee is provided. Drug treatment of Osgood-Shlyattera disease is based on the use of
painkillers and anti-inflammatory drugs. There is used various methods of physical
therapy: magnetic therapy, mud therapy, shockwave therapy, UHF, massage of the lower
limbs, paraffin. Surgical treatment is carried out only in severe destruction of bone of the
head of the tibia. The operation removes necrotic foci, and filed a bone graft, which fixes
the tuberosity of the tibia.
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ENDOGENOSUS DEPRESSION
Voronina A. - the 6th year student
Scientific leaders - Brush N.G., Kostina V.V.
Endogenous depression (melancholia) is an atypical sub-class of the mood disorder,
major depressive disorder (clinical depression). Endogenous depression occurs due to the
presence of an internal (cognitive, biological) stressor instead of an external (social,
environmental) stressor. Endogenous depression includes patients with treatment-resistant,
non-psychotic, major depressive disorder, is characterized by abnormal behavior of the
endogenous opioid system but not the monoaminergic system.
Symptoms. The forefront indication of a depressive episode is manifesting is the
sudden loss of energy or motivation in daily routines. When this occurs, it is not uncommon
for individuals to seek medical attention with excessive worrying or anxiety that a more
severe, physiological disease may be the underlying issue. However, without an actual
disease present, this neurotic thinking often results in severe anxiety, sleep disturbance,
and mood swings which may hinder social relationships. Individuals with endogenous
depression may experience inconsistencies in symptom severity ("the swing of affect")
which is often the reason for delayed treatment. If left untreated, symptoms may progress
to a major depressive episode.
Treatment. Individuals suffering from endogenous depression require treatment plans
that focus on the internal, cognitive thought processes since internal stressors are the root
of somatic symptoms. Individual cognitive therapy (ICT) is therefore a common treatment
used to gain insight to the individual's internal conflicts or thoughts that are motivating
their distressing symptoms. Once the cause of the symptoms are identified, sessions are
used to develop new coping skills, behavior modification, and changes in beliefs. As
preventative measures, pharmaceuticals such as SSRI's and antidepressants may also be
utilized to avoid further development or progression to Major Depressive Disorder. There
have been few treatments targeted specifically toward Endogenous Depression; therefore,
symptoms are often managed similarly to Major Depressive Disorder. One such treatment
is electroconvulsive therapy (ECT). ECT is used as a treatment option for endogenous
depression in adults, however, practitioners avoid the use of ECT in young adolescents due
to rates of injury.
CHRONIC TRAUMATIC ENCEPHALOPATHY
Prygunov V., Marushko L. - the 3rd year students
Scientific leaders – Can.Med.Sc. N.V. Menschikova, N.R. Levchenko, E.A.Volosenkova
Chronic traumatic encephalopathy (CTE) is deterioration of the brain caused by
the accumulation of tau protein. Damage of the brain during CTE can lead to serious mental
and physical disabilities. Disease worsens over time. CTE is caused by multiple blows to
the head, resulting in a concussion. Brain Injuries lead to disorders of consciousness and
thinking, physical problems, emotional and behavioral disorders, which may occur years
later. Single or series of concussions do not necessarily cause the development of CTE.
CTE is a neurodegenerative disease and leads to progressive damage of the nerve cells and
noticeable changes in the brain. Some of these changes can be seen in brain scans, but an
accurate diagnosis can be established only after the death of the patient. Now methods of
CTE diagnostics are being developed with patient's life. CTE, formerly known as the
missed shock syndrome, dementia or boxers dementia pugilistica, was first established in
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boxers. People involved in contact sports, in which repeated blows to the head occur
(martial arts, football, rugby and others), are at increased risk of CTE. The disease can
develop in soldiers injured in the explosions. The exact causes of CTE are not quite clear
for science. Currently CTE is incurable.
FIBROELASTOMETRY OF THE LIVER
Belukhin V., Belyaeva Y.– the 4th year students
Scientific leaders - Can. Med. Sc. M.V. Sulima, E.A. Volosenkovа
Fibroelastometry of the liver is - innovative research of the liver state without surgery.
The basis of this research method is the determination of the velocity of electromagnetic
impulses that are sent to the patients liver using a special device Fibroscan. Initially, the
impulses pass through the skin, liver, and then spread throughout the body. On the side of
the chest of a human a special sensor is attached the purpose of which is to capture the
impulse. The slower the signal passes through the tissue, the higher the probability of their
damage by any pathology is. For information about the status of all body areas
fibroscanning of the liver is repeatedly performed from different perspectives. Then all the
figures are added up, the average value is displayed, indicating the state of the organ
tissues. The values resulting from scanning are interpreted with the following organ
conditions: healthy - to 6 kPa; the 1 stage of fibrosis - 6 - 6.6; the 2 stage of fibrosis - 6.6
- 8.5; the 3 stage of fibrosis - 8.5 - 10.3; the 4 stage of fibrosis - 10.3 - 20.8; clinical
cirrhosis is more than 25.6. Fibrosis is the replacement of normal liver tissue with scar
tissue that disturbs the functioning of the organ. The amount of scar tissue connective
tissue provides an indication of the stage of liver disease.
Indications for the study: chronic viral hepatitis, liver cirrhosis, cryptogenic hepatitis,
autoimmune hepatitis, fatty liver, alcohol induced liver disease with evidence of cytolysis
and cholestasis, toxic liver disease, sclerosing cholangitis.
Contraindications: patients age to 18 years, the presence of ascites, patients with
pacemakers, pregnant women.
Fibroscanning method gives complete information about the structure of the liver that
allows to differentiate the pathology and appoint competent treatment.
HEADACHES IN THE 4TH YEAR STUDENTS OF THE AMUR STATE
MEDICAL ACADEMY
Gonakova V., Belyaeva Y. – the 4th year students
Scientific leaders - Doc. Med. Sc. V.N. Karnaukh., E.A. Volosenkovа
Topicality: headache (HA) is one of the most frequent complaints, with which patients
come to doctors of various specialties, is a general medical problem. HA is the most
common cause of long-term disability and loss of quality of life, that gives it an important
social and economic significance. Fruitless searches of structural changes in the brain in
HA and the lack of effectiveness of treatment create diagnostic and therapeutic difficulties
for doctors of different specialties.
Epidemiology: Headache is a common symptom and according to some authors detected
in approximately 85% of individuals in the general population. HA is more typical for
women (88%), for men it is less typical (69%).
Objective: To carry out a survey among students of the 4th year of the Amur State Medical
Academy, in order to identify the shape and character of HA.
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Results: A survey of 40 students of the 4th year of the Amur State Medical Academy, aged
19 to 23 years was carried out. Answering the question of "localization of HA" 31 people
said that the whole head hurts, especially the parietal and occipital regions in 7 patients
pain in the eyes and forehead, in 2 persons- one half of the head; Answering the question
of the nature of pain, 20 people indicated squeezing pain, 11 - throbbing pain and 9 persons
bursting inside pain Answering the question "how often are attacks of HA repeated? "the
majority of people (33) reported 1-2 times a month or less, 6 people 2, 3 times a week and
only 1 had pain every day; Answering the question: "Does the weather conditions provoke
headache" 35 people said "yes" and "15" does not; Answering the question "How long
does a headache last?" 33 people said that HA lasted a few hours; 2 people said that it
lasted up to the day or a few days, and 5 people said the pain lasted all day. To the question
"what is the HA accompanied by?" 35 students noted no symptoms, and only 5 point to
nausea and sensitivity to light;
Conclusion: The survey showed that the majority of students were concerned about tension
headache. Also, there are those who have symptoms, which are characteristic of migraine.
They are 11 respondents; and 7 students experienced clustered pain.
ENDOGENOUS DEPRESSION
Shelikhan О., Belyaeva Y.– the 4th year students
Scientific leaders - N.G. Brush., E.A. Volosenkovа
Endogenous Depression is a mental disorder, the classic manifestations of which are
depressed mood, motor inhibition and slow thinking.
Etiology: this emotional disorder refers to diseases of predisposition. It may be caused by
a genetic factor. The reduced adaptive human capabilities, dysregulation of certain
substances in the body, such as serotonin, norepinephrine, dopamine are transferred
hereditaryly, there is a shortage of these substances in the body. The development of the
disease may be caused by an external action - traumatic situation,
internal diseases,
taking certain medications, neurological pathology.
The main symptoms of depression are depressed mood, slow thinking and motor
retardation. These symptoms are called as the triad of Kraepelin.
The mainstay of treatment of endogenous depression is the use of drugs. The most common
antidepressants are - sertraline, fluvoxamine, cipramil, fluoxetine. Another group of drugs
used for the treatment and as maintenance, preventive therapy are mood stabilizers. This
group of drugs includes lamotrigine, finlepsin. Prolonged use of mood stabilizers helps
stabilize mood, prevents the development of depressive episodes. Psychotherapy is used
only as an adjunct to medical treatment. Psychotherapy contributes to the solution of
problems and conflicts.
People suffering from this
mental disorder, should avoid an excessive load on the psyche, work at night, alcohol
abuse, they must maintain a healthy lifestyle.
NODULAR ERYTHEMA
Belyaeva Y. – the 4th year student
Scientific leaders - Doc. Med. Sc. V.V. Schimko., E.A. Volosenkovа
Nodular erythema is inflammation of the skin and subcutaneous vessels having an allergic
genesis and formation of dense manifested painful inflammatory hemispherical nodes of
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various sizes. Very often the process is localized on the symmetric parts of the lower
extremities.
The basis of the formation of nodular erythema is the sensitization of any origin. Causes:
infections (tuberculosis, streptococcal infections, yersiniosis); autoimmune diseases
(ulcerative colitis, Crohn's disease); intake of a number of drugs (iodides, antibiotics,
bromides); vaccination; sarcoidosis; oncological diseases; heredity
Symptoms: nodular erythema is characterized by the features – dense to the touch nodes
sometimes without clear boundaries; with hemispherical shape; painful; without pruritus;
of up to 5 cm in size.
Skin, located on them, is hyperemic and smooth; with indistinct borders; localized mainly
in front part of the shins.
According to variants of the clinical course: acute; chronic nodular erythema are
distinguished.
The first of them occurs suddenly and is accompanied by a rise in temperature, joint
disease. The duration of the acute variant is about a month. Chronic case lasts for months,
in addition to skin manifestations patients suffer from joint pain.
Treatment: hypoallergenic diet; antibiotics (erythromycin, doxycycline, penicillin); antiinflammatory drugs (hormonal and non-hormonal); desensitizing agents; hemosorption
and plasmapheresis; physiotherapy (magnetic therapy, ultraviolet irradiation, laser therapy,
phonophoresis).
Treatment prognosis of nodular erythema is favorable for the patient.
HEALTH BENEFITS OF PING PONG / TABLE TENNIS
Kanarsky N. – the 2nd year student
Scientific leaders – prof. Borodin E.A., ass.Volosenkova E.A.
Table tennis originated in Victorian England, where it was played among the upper-class
as an after-dinner parlour game. It has been suggested that makeshift versions of the game
were developed by British military officers in India in around 1860s or 1870s, who brought
it back with them. The game is widespread in Europe and Asia in XX century and became
extremely popular in some countries like China.
Whether you’re playing doubles or singles, table tennis, or ping pong, can be a fast-paced
competitive sport. In fact, when played at an intense rate, it can be a great way to burn
calories and get fit.
Top 10 Health Benefits of Ping Pong:
 Playing improves hand-eye coordination and it stimulates mental alertness,
concentration and tactical strategy. This makes it the perfect game for young people
to sharpen reflexes, and for older people to refine tactics.
 Develops mental acuity. The speed, spin and placement of the ball are crucial in
table tennis, and practiced players are highly skilled in both creating and solving
puzzles involving these three attributes.
 Improves reflexes. Due to the fast-paced, short-distance nature of the sport, both
gross and fine muscle movements are improved. The game is distinguished by
bursts of exertion and recovery, leading to fast-twitch muscle development.
 It’s easy on the joints. Have you had knee surgery, back problems, tired of twisting
your ankles? Try table tennis. It’s a great way to improve your leg, arm and core
strength without overtaxing your joints.
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Burns calories. A 150-pound person can burn 272 calories by playing table tennis
for an hour. Considering the fact that the sport is entertaining and addictive, it can
be a fun and easy way to burn calories.
Offers a social outlet. Whether you play in the community center or at home with
friends, table tennis offers a great way to bond with other people while you lose
weight. Because young and old people can play the game, it can help improve
communication and build relationships, irrespective of age. Playing at home with
siblings or parents can bring family members closer and enable them to spend more
quality time with each other.
Keeps your brain sharp. Alzheimer’s Weekly reports a clear increase in motor
skills and cognitive awareness from playing table tennis, after a series of preliminary
clinical studies in Japan found that table tennis markedly increases the flow of blood
to the brain, and could possibly even prevent dementia.
Improves coordination. Following the ping pong ball as it moves quickly toward
you, and following its trajectory as your opponent hits it helps improve hand-eye
coordination.
Improves balance. Staying balanced and being able to quickly change direction are
key to being successful in a ping pong rally. This is especially important for the
elderly.
Stimulates various different parts of the brain. By anticipating an opponent’s
shot, a player uses the prefrontal cortex for strategic planning. The aerobic exercise
from the physical activity of the game stimulates the hippocampus, the part of the
brain that is responsible for allowing us to form and retain long-term facts and
events.
FEATURES OF PREGNANCY IN WOMEN WITH MILD CARDIAC
ANOMALIES
Lukianova K., Cherednichenko O. – the 6th year students
Scientific leaders – A.P.C.M.S. O.N. Sivyakova, E.A. Volosenkova, O.A. Dedkova
Functional disorders and conditions associated with minor cardiovascular
abnormalities (MCA) are very important in the structure of cardiovascular diseases.
Nowadays, MCA are associated with undifferentiated dysplasia of the connective tissue.
Undifferentiated diffuse connective tissue is of the special interest in obstetrics and may
cause different complications in pregnancy and baby birth. Basically, cardiologists have
no objection to carry a pregnancy.
The aim of the study was to determine the peculiarities of the pregnancy and baby
birth and condition of the newborns.
Materials and methods: individual cards of the pregnant women, case histories of
pregnant and clinical records of patients with MCDA and congenital heart diseases
(CHD) who have record in the maternity consultation centre №1 in Blagoveshchensk.
Results: Case histories of 17 women with middle age of 27,3±1,48 years was
studied. 9 of them (52,9 %) are primipara and 8 of them (47,1 %) are deutipara. 2 of
them (11,7 %) are up to 20 years old, 8 (47,1 %) are 20-29 years old, 4 (23,5 %) – 3034 years old, 3 (17,6 %) are over 36 years old.
7 women had mitral valve prolapse (MVP) of the 1 st. degree and 1 women had
MVP with no regurgitation. Every second pregnant women (9 women, 52,9%) had atrial
septal aneurysm, 3 woman (17,6%) had patent foramen ovale (PFO), and one case of
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ASD, VSD, and open aortic flow (OAF) respectively. Every third pregnant woman
(29,5%) had additional chord in the left ventricle and myocardiodystrophy.
Compensated chronic fetoplacental insufficiency (CFI) was the most common
complication of pregnancy and was diagnosed in 9 women (52,9%). Preeclampsia
moderate severity and gestational diabetes were diagnosed in 17,6%.
The average rating of newborns by Apgar score was 8/8.
Conclusions cardiovascular system decompensation (tachycardia and cardiac
overload) was diagnosed in 2 women of 17 (11,7%). Various pregnancy complications
were identified in more than half of the cases.
THE EXPERIENCE OF APPLICATION OF DETOXICATION
PLASTERS IN COMPLEX TREATMENT OF PATIENTS WITH
DISEASES OF BILIARY SYSTEM AT THE OUT-PATIENT AND
POLYCLINIC STAGE
Bairamova A., Lukyanova K., Glushkova N. - the 6th year students
Scientific leaders - O.M. Goncharova, E.A.Volosenkova
There is a great number of patients with gastroenterologic diseases at both on
incidence indicators, and on number of polyclinics including both: morbidity indices
and the number of visits to the doctor.
Recently, the role of a polyclinic stage increased in treatment of patients with
diseases of biliary system which consists of carrying out a basic course of treatment,
and further in implementation of a wide complex of rehabilitation actions.
Purpose. To study the efficiency and tolerance of impact of detoxication
plasters with tourmaline on acupuncture points in patients with diseases of biliarny
system.
Materials and methods. 30 patients at the age of 45-66 years, were examined.
All patients were divided into 2 groups. The first group (15 patients) received
standard treatment, according to the established diagnosis. In the second group (15
patients) against the background of complex treatment, on feet in a zone of a
projection of a liver and gall bladder detoxication plasters with tourmaline were
applied.
Results. In all patients of both groups who received complex treatment
indicators of cytolytic and holestatic syndromes decreased and normalized (81% and
92% according to groups). According to ultrasonography, in all patients positive
dynamics of a biliary tract was observed: (70% and 85% respectively), Thus, the
conducted research showed that application of the detoxication plasters in complex
treatment of patients with chronic cholecystitis and fatty dystrophy of a liver gives
the chance to achieve of more expressed positive dynamics in patients.
BIOCHEMICAL COMPOSITION OF BILE
Stepanshina T., Savich M. – the 2nd year students
Scientific leaders - Assoc. Prof., Doc. Med. Sc. E.V.Egorshina, E.A.Volosenkova
The human bile mainly contains cholic, chenodeoxycholic and deoxycholic acids.
Also in human bile in small quantities lithocholic acid, allocholic and ureodeoxycholic acid
are contained. Bile acids present in the bile in a conjugated form, i.e. as glycocholic,
glycodeoxycholic, glycochenodeoxycholic or taurocholic, taurodeoxycholic and
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taurohenodeoxycholic asids. These compounds are called paired bile acids, since they
consist of two components - of the bile acid and glycerol or taurine. Bile pigment bilirubin
is an excreted product of hemoglobin metabolism and gives the bile it a characteristic
golden yellow color. In hepatocytes bilirubin forms water sdublr with glucuronie asid
conjugates and, in small quantities, with sulfates. Urine pigments and kalaurobilin,
urochrome and stercobilin are formed of the bile pigments.
Pathologies. Cholelithialis Biochemistry of cholelithiasis consists of the following
main principles. The formation of cholesterol stones. Normally, the liver secretes a certain
amount of cholesterol in the composition of bile. In case of the original excess of
cholesterol with bile produced its excess can form small crystals deposited in the
gallbladder. Elevated bile concentration leads to the fact that these small crystals gradually
stick together, forming an increasingly large concretions. Ultimately, this stone is able to
completely block the lumen of the bile ducts and cause severe pain. The formation of
pigment stones. Together with cholesterol in the bile secreted by the liver a certain quantity
of bilirubinenters. Bilirubin may be present in two fractions: free and bound. In the free
fraction excess of bilirubin in bile it interacts with minerals (particularly with calcium).
The result of this interaction is the formation of small pigment stones, which gradually
increase in size and become quite solid in weight in the development of gallstones.
BRONCHOALVEOLAR LAVAGE
Maysak A. – the 2nd year student
Scientific leaders –Doc. Med. Sc. Prof. N. P.Krasavina, E. A.Volosenkova
Bronchoalveolar lavage is a bronchoscopic way of receiving washout from a surface
of a bronchial tree and alveolar structures of the lungs for cytologic, microbiological,
biochemical and immunologic researches. As a result of the procedure of bronchoalveolar
lavage various on structure and a source portions of lavage liquid – the bronchial washout
(BW) and bronchoalveolar washout (BAW) are received.
Now the research of cellular structure of the BAW, the so-called endopulmonic cytogram
is most widespread. The normal cellular structure of BALF in non-smokers per 100-300
ml of liquid is presented by alveolar macrophages (to 90%), mainly band leukocytes (1–
2%), lymphocytes (7–12%), and also cells of an epithelium of bronchial tubes (1–5%).
Research BALL also allows to estimate a condition of surfactant system of lungs by
means of measurement of the interfacial tension and studying of phospholipid composition
of surfactant.
The main immunologic indicators of structure of BALF are alveolar macrophages which
play an important role in immunity reactions, and this responsibility depends on their
viability and the functional state. Also important biochemical indicators of composition
are leukocytes, and lymphocytes. V-lymphocytes make 5-10%, zero cells - 19%. Of
particular interest are researches of cytokines — proteins mediators of various cellular
reactions.
Research of BAW allows to estimate a degree of activity of inflammatory process in
infectious diseases and effectiveness of the carried-out therapy. Also on cytologic changes
in composition of the BAW one can judge about various pathologies of a bronchial tree.
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THE PROBLEM OF PROTEIN MALNUTRITION IN THE DEVELOPING
COUNTRIES
Chernysheva A., Maysak A., Leshtaeva U. – the 2nd year students
Scientific leaders – Assoc. Prof., Doc. Med. Sc. E.V. Egorshina, E.A.Volosenkova
Protein deficiency can occur in two ways. Firstly, the food can contain sufficient
energy, but not protein. It is common in parts of Africa, where the staple food is maize or
cassava, i.e. cultures - rich in starch, and therefore energy, but poor in protein. The corn
flour lacks the essential amino acid tryptophan, without which proteins can not be
synthesized. In areas where wheat grows, protein deficiency is rare.
The second cause of protein deficiency is the low energy content in food. In this situation,
as a power source the body's own proteins are used.
Kwashiorkor. For the first time the disease was described in 1935 in Ghana; its name comes
from the word for "sick child that is weaned of the breast immediately after birth."
Symptoms of Kwashiorkor include: 1) the hair become thin, brittle, sparse, easy to
fall and often lose their pigmentation; 2)the salivary glands are affected; they are greatly
increased, resulting in a distinctive face, "crescent-shaped" appearance; 3) abdomen
becomes swollen due to accumulation of gas in the intestine, where excessive growth of
bacteria occurs; 4) swelling appears resulting from fluid accumulation in the tissues of the
body, 5), muscle dystrophy, underweight and stunted growth; mental development is also
slow; 6) spotty skin pigmentation and spider veins occur; skin becomes rough; wound
healing is difficult; jaundice may occur; 7) interest in the outside world weakens, there is
irritable apathy; 8) fatty live;
9) vitamin deficiency diseases lead to characteristic symptoms of these conditions,
especially with a deficiency of vitamins A and D; 10) decreased resistance to infection.
Kwashiorkor is often fatal.
INFLUENCE OF SYMPATHETIC NERVOUS SYSTEM
Leshtaeva U., Chernysheva A.,Maysak A. – the 2nd year students
Scientific leaders - Can.Biol. Sc. S.N.Gasanova, E.A.Volosenkova
Phenomenon of Orbeli-Ginetsinsky was discovered in 1923. In experiments on
neuromuscular preparation motor fibers were stimulated by electrostimulator. Isolated
muscle contracted in response to each of the rhythmically repetitive stimuli, and on the
tape of kymograph typical curve of muscle contraction was recorded. The amplitude of
the curve decreased at fatigue. After stimulation of the sympathetic nerves, there was an
increase in the amplitude of muscle contractions, and kymograms showed a new wave of
increased activity. Later, the phenomenon was confirmed in mammalian muscles during
normal blood supply.
LA Orbeli put forward an idea of a universal adaptive-trophic function of the
sympathetic nervous system, which regulates the functional properties of all organs and
tissues, setting them at an optimum level for the given conditions. This regulation is not
limited to smooth muscles and glands, it covers all parts of the reflex arcn - receptors,
central nervous system, nerve guides, and skeletal muscles.
At the heart of the phenomenon of Ginetsinsky Orbeli-activation of the sympathetic
nervous system lies. Further investigations revealed a common effect of the sympathetic
nervous system and the reticular formation of the brain on restoration muscle health.
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SAYANO-SHUSHENSKAYA POWER STANTION ACCIDENT
Bivzyuk E., Bivzyuk V. - the 2nd year students
Scientific leaders - E.V. Egorshina, E.A. Volosenkova
On the 17th of August, 2009 at 8:13 AM, the hydro-electric plant suffered from a
catastrophic accident caused by flooding the turbine room, and explosion of two electric
generators under the water as a result of a short circuit. All other machinery was damaged
to some extent, and only four hydro-aggregates were ultimately restored; the remaining six
ones required replacement. 76 persons, including 1 pregnant woman, were confirmed dead.
Power generation from the station ceased completely following the incident, with
the resulting blackout in residential areas being alleviated by diverting power from other
plants. Aluminium plants in Sayanogorsk and Khakassia were completely cut off from the
grid before power supplies were replaced using alternate power sources. Russia warned
that in the longer term it might lose up to 500,000 tons of aluminum output due to the
power shortage, and called for accelerating the construction of the Boguchanskaya
hydroelectric power station to replace lost generating capacity.
The accident caused an oil spill with at least 40 tonnes of transformer oil released,
spreading over 80 km downstream of Yenisei.
LIPODRENE
Peshkova D., Hvatov I. – the 2nd-year students
Scientific leaders – E.V. Egorshina, E.A. Volosenkova
Lipodrene - one of the best fat burners provided on the sports nutrition market.
Unlike competing-lipotrop additives in its composition it has only ingredients, which
effectiveness and safety are verified directly by experiment.
The main advantages of the use of Lipodrene
- It is an excellent termogen, accelerates metabolism –
- Blunts excessive appetite, makes it easy to stick to your diet –
- Improves performance, mental activity –
- Removes the accumulation of new fat deposits –
- Allows you to get rid of fat as soon as possible –
The main components of Lipodrene :
Ephedra. Ephedrine stimulates the central nervous system and reduces the
feeling of hunger. It speeds up metabolism and increases muscle endurance.
Acacia Rigidula. Yields adrenaline. It activates the thyroid gland, which helps
the body convert excess of fat into energy. It improves attention and concentration, which
are significantly worse during diet.
Citrus Aurantium. Characterized by active fat-burning effect, formed due to
the increase in body temperature. Also reduces appetite, it adds energy and increases
endurance during exercise.
1,3-Dimethylamylamine (geranium). It has a similar effect to the effect of
caffeine. But it is much stronger than it. It provides a powerful energy charge.
Cassia Nomame. Expels the excess water from the body. That will protect you
from edema and hypertension. It improves bowel function.
Evodiamine. Burns fat and charges the body with energy. It improves
metabolism.
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Yohimbe. It dilates blood vessels, which helps muscles be better saturated with
oxygen and nutrients. In this regard, tolerance increases and metabolism improves. It
improves mood.
Naringen. It improves the digestibility of all components of Lipodrene
Hardcore. It improves glucose metabolism.
6,7 Dihydroxybergamottin and 5-Methoxytryplamine HCl prolong operation
of the components contained in the preparation. For CNS stimulation in Lipodrene
hardcore mixture Tri-Xanthine is responsible which contains Yerba Mate Extract, Green
Tea Extract, Theobroma Cocoa, less rich with less harmful caffeine analogues.
THE PREVENTION OF HEMATOGENOUS THROMBOPHILIA THROMBOTIC
COMPLICATIONS
Kolnauz T. – the 6-th year student.
Scientific leader - Voitsekhovsky V.V.
The World Health Organzation and ISTH consider hematogenious thrombophilia as
unusual tendency to thrombosis with the beginning in early ages, family heredity, severity
of thrombosis, which is disproportionate to well-known causal factor and episodes of
thrombosis recurrence. During the diagnosis determination we used the recommendations
of the American Assisiation of Thoracic Antithrombotic and Thrombolytic Therapy
Physicians (2008) who determined the thrombophilia as the presence of one or more signs:
deficiency of antithrombin, proteins C and S, resistance to activated protein C, mutation of
V Leiden factor, mutation of prothrombin G20210A, hyperhomocysteinemia, homozygous
carriage of the thermolabile variant of MTHFR, antiphospholipid antibodies, increased
activity of factor VIII or reduced levels of protein Z.
Recently new oral anticoagulants has appeared, for example, the direct thrombin
inhibitors dabigatran (dabigatran etexilate) and factor XA – rivaroxaban and apixaban.
In the Amur Region dabigatran (pradaxa) was given to 30 patients with
hematogenous thrombophilia in age from 20 to 50 years in order to prevent blood clots.
All patients have a combination of several thrombogenic factors. There is an infomation in
their histories: 18 patients have the pulmonary embolism (recurrent in 12 cases), 4 patients
have the ischemic stroke, 2 patients have the myocardial infarction, 26 patients have a
vascular disorder of the lower extremities. The drug was not appointed for patients with
antiphospholipid syndrome. The patients took dabigatran from five years to several
months. The dose was selected individually from 150 to 220 mg per day. 6 patients had
hyperaggregation platelet except all the other factors and their therapy was combined with
acetylsalicylic acid. The protein C and antithrombin III in their congenital deficiency were
also used. After using dabigatran the recurrence of life-threatening thrombotic
complications was not noticed as well as hemorrhagic complications. 12 patients lived in
long-distanced areas and could not regularly monitor their koagulograms.
CLINICAL COURSE AND MODERN APPROACHES TO THE TREATMENT
OF PNEUMONIA
Alieva A. – the 5th year student
Scientific leaders - Dr.Med.Sc O.B. Prikhodko, ass. I.V. Kostrova
Respiratory pathology now has the leading role in morbidity structure of adult
population. The incidence of pneumonia in the Amur region is an average of 574.1 cases
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per 100 thousand citizens, which is higher than the all-Russian level by 31% (396.8 per
100 thousand.). In connection with this there is an interest in studying of the clinical
characteristics of the course and approaches to the treatment of pneumonia at the current
stage.
163 case histories of patients were analyzed for the period 2014.The clinical and
radiological features of CAP flow, distribution of patients by sex, age, the severity of the
pneumonia, outcome of the disease, presence of complications, terms of the initiation of
antibiotic therapy, the clinical efficacy of the initial antibiotic and antiviral therapy were
studied.
It was revealed that there were 96 men (58.8%) and 67 women (41.1%) among the
patients with pneumonia. The age structure was as follows: at the age of 18-40 years - 32
patients (19.6%), 41-60 years - 59 (36.1%), 61-80 years - 51 (31.2%), 81 or older - 21
(15.4%). The diagnosis of pneumonia and the using of antibacterial therapy during the first
day of onset noted in 31 cases (19%) within 7 days of onset - in 125 cases (76.6% men),
for 14 days or more - 7 cases (4.2%).By the degree of severity of pneumonia patients were
distributed as follows: in 97 cases (59%) - to moderate in 68 (41.7%) - heavy.
From the first day of treatment in hospital patients received antibiotics following
pharmacological groups: aminopenicillins advantageously inhibitors-protected,
cephalosporins basically III generation, modern macrolides, respiratory fluoroquinolones,
carbapenems. 78.5% of patients (128) were on combination therapy: antibacterial and
antiviral (Ingavirin, oseltamivir).
Effect of receiving treatment was assessed by clinical and radiographic dynamics of
the disease: a positive trend within 7 days from the start of treatment was observed in 125
patients (76.6%), for 14 days - in 34 (20.8%). The dynamics of X-ray pictures of patients
receiving antiviral therapy was studied: a positive trend - in 115 cases (89.8%), for 14 days
or more - in 13 (10.1%).In a satisfactory condition were discharged: 144 patients (88.3%),
with the formation of morphological defects - 14 (8.5%), death - 4 (2.4%). In one patient
outcome could not be traced - refuse of further treatment (0.6%).
According to the analyzed data, sequential approach to the appointment of
antibacterial therapy is carrying out which is assuming a two-stage application of
antibiotics.The main idea of sequential therapy is to reduce the parenteral antibiotic
therapy, which provides a significant reduction in the cost of treatment and reduce of
patient’s length of stay in the hospital while maintaining high clinical efficacy.
THE EFFECT OF HIGH AND LOW TEMPERATURES ON THE HUMAN BODY
Palachik T., Doenina O – the 3rd year students
Scientific leaders - E.V. Litovchenko, E. A. Volosenkova
Even in ancient times, our ancestors knew that health and all the vital processes
also depend on the weather and other natural phenomena.
The effect of temperature on the body is most pronounced in the industrial environment
where there may be high or very low temperatures. Long stay of a person in such conditions
causes stress of thermoregulatory mechanisms, which is regarded as a stressful situation.
Low air temperature, increasing the heat creates the risk of hypothermia. Abrupt decrease
in the air temperature is especially harmful to human health.
Cold reduces aggression, rejuvenates and prolongs life, improves sleep, helps to
heal diseases, lose weight and get rid of depression.
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Under the influence of bath procedure, the body's ability to work and its emotional
tone increase recovery processes after intense and prolonged physical activity accelerate.
As a result of regular visits to the bath the body's resistance to colds and infectious diseases
increases. Stay in the sweating room causes dilation of blood vessels, increases blood
circulation throughout the body. Under the influence of high temperature sweat is
intensively exuded to assist the removal of harmful products of metabolism from the body.
For a long time scientists thought the warmer weather was more comfortable for
the human body, but, having studied the effect of the cold in detail, they found that the low
temperature is more useful for health. Scientists of Harvard University have proved that
heat for a human is five times more dangerous than the cold. Mortality in severe cold,
increases by 1.59%, but it is still lower than the mortality rate in the intense heat, which
increases by 5.74%.
POLYNEURITIS
Sechkareva M., Khnykina I., Buryachenko T., Cherepanov A – the 3rd year students
Scientific leaders - Can. Med. Sc. N.N.Dorophienko, E.A. Volosenkova
Polyneuritis -is a disease characterized by multiple disorders of peripheral nerves.
It is manifested in the form of a paresis, desensitization, and also in the form of various
disorders of trophic type.
Causes:
• Complications after infectious diseases
• Complications of systemic diseases;
• Intoxication
• Metabolic disturbances in uremia, nephritis or diabetes;
• Malabsorption of nutrients
• Hypovitaminosis associated with a deficiency of vitamin B1;
• Autoimmune disorders.
Symptoms:
The disease begins with formication, cooling and numbness in hands and feet, feeling chill
in them, even in hot weather, the appearance of aching or shooting pains in the extremities.
Gradually weakness in the legs, unsteady gait occur, it becomes difficult to keep things in
the hands. Limb muscles are reduced in volume (atrophy).Desensitization occurs,
especially in the hands and feet - the type of "Gloves" and "socks".
Treatment:
In the acute period bed rest is necessary. In addition to drug treatment, to physiotherapy,
exercise therapy may be administered in the chronic course - spa treatment. Prevention of
polyneuritis with common infectious diseases and metabolic disorders is possible if the
underlying disease is treated in a timely manner. To prevent toxic polyneuritis in the
respective industries rigorous safety regulations are developed. If these rules are followed
then entering toxic substances into the body is excluded. When working with pesticides
polyneuritis can be avoided if you follow the instructions on the use of these substances.
HARDENING
Tsyrenzhapova I., Sechkareva M. – the 3rd year students
Scientific leaders - E.A. Litovchenko, E.A. Volosencova
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Hardening is a system of preventive measures aimed at the body's resistance to
adverse environmental factors. Revitalizing hardening helps the body to enhance
adaptation to environmental conditions. That is a seasoned body even at considerable
fluctuations in the environment temperature maintains the temperature of the internal
organs in a fairly narrow range.
Besides human tempering increases stamina, strengthens the nervous system,
enhances immunity and resistance to disease. Hardening is considered to be one of the best
ways to maintain health.
Principles of hardening:
 individual approach;
 gradualness and succession;
 consistency;
 a combination of local and general procedures;
 a variety of forms and means;
 self-control;
 active lifestyle.
The main methods of hardening include:
1. Air baths are the impacts of natural air to completely naked body.
2. Sunbathing is direct sunlight influence on the human body for its healing and prevention.
3. Barefoot walking in the cold time walking is in a short time, after getting used to it the
walking time increases.
4. Contrast douche - is pouring with cold and hot water (in turn).
5. Pouring with cold water - less than 1 time a day.
7. Rubbing with snow – it is necessary to start gradually you can even drag a towel first
time in the snow and dry yourself with it.
8. Bathing in the hole is for the most hardened people.
GASTRIC LEIOMYOMA
Kadeneva V., Rudenko A. - the 3rd year students
Scientific leaders - Can.Med. Sc. L.A. Volkov, E.A.Volosenkova
Benign gastric tumors without epithelizaition make up refer to rare diseases and
0.5-5% of all gastric tumors. Leiomyoma – is a benign tumor which develops in the
gastrointestinal tract smooth muscle tissue. Among BGT, leiomyoma is the most common.
It may be localized in the esophagus, stomach, intestines. Leiomyoma of the stomach is
formed in patients aged 16-18 years and manifests to 30-50 years. It is more common in
the combination with gastric ulcer, chronic gastritis, sometimes with other gastric tumors,
including malignant. Leiomyoma is usually a single tumor. With long-term existence of
the tumor its surface becomes uneven, sometimes ulcerated.
At the break leiomyoma has grayish-pink color, fibrous structure, clear contours.
According to the nature of the growth tumors with endogastral, xogastrlan, intromuralnym
spread are isolated. Clinical manifestations are diverse. Often, they are asymptomatic. The
disease can first appear with such complications as gastric bleeding, perforation of the
tumor. Patients may complain of epigastric pains, indigestion, weight loss, weakness, tarry
stools. In some patients, the tumor is palpable. For the diagnosis of leiomyoma endoscopic,
radiological, ultrasonic methods, computed tomography are used. Treatment is only
operative. The volume of the operation depends on the size and location of the tumor: the
tumor enucleation – is a wedge and partial gastrectomy.
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ACUTE PANCREATITIS
Pak E., Pushkov A. – 3rd year students
Scientific leaders - Doc. Med. Sc. - I.Y Makarov, S. A. Peschanskaya, A. I. Petrakov,
E.A. Volosenkova
Primary acute pancreatitis complicates many infectious and non-communicable
diseases. Acute pancreatitis, uncomplicated by necrosis of the pancreas, has the vague
clinical picture. The penetration of infection in the pancreas may be hematogenous,
canaliculate — through the pancreatic duct and the contact.
According to the nature of the process there is serous, catarrhal and purulent
pancreatitis. Pancreas with serous pancreatitis is swollen, opaque, pink. Cloudy swelling
of the epithelium and edema of the interstitial tissue with lympholeukocyte infiltrations
are observed microscopically. Catarrhal pancreatitis is characterized by a mucopurulent
exudate in the ducts with epithelial desquamation and leukocytic infiltration of the
interlobular connective tissue and all layers of the ducts. Catarrhal pancreatitis may be
complicated by stone formation or suppurative pancreatitis, which occurs in two forms —
pertaining to apostema phlegmonous. All forms of acute pancreatitis can turn into the acute
necrosis of the pancreas.
FACTORS AND MECHANISMS OF NONSPECIFIC ANTI-INFECTIOUS
DEFENSE OF THE BODY
Pushkov A., Pak E. – the 3rd year students
Scientific leaders - Can. Med. Sc. O.V. Bubinets, E.A. Volosenkova
The state of macroorganism is very important along with the properties of the
pathogen in case of infection. It is determined by a complex set of factors and mechanisms
that are closely related to each other, is characterized as the susceptibility (sensitivity) or
immunity (resistance) to infection.
The innate factors of nonspecific immune defense of the body include: skin and
mucous integuments, lymph nodes, lysozyme and other enzymes of the oral cavity and the
gastrointestinal tract, normal microflora, natural killers (NKK) and phagocytic cells.
The skin and mucous membranes. For most microorganisms, including pathogens
the intact skin and mucous membranes are a barrier to their penetration into the body.
Constant desquamation of the upper layers of the epithelium, secretion of sebaceous and
sweat glands help to remove microorganisms from the skin surface. However, the skin is
not only a mechanical barrier, it also has bactericidal properties associated with the action
of lactic and fatty acids, various enzymes secreted by sweat and sebaceous glands.
Therefore, various microorganisms that are not included in the number of permanent
inhabitants of the skin, quickly disappear from its surface.
The lysozyme. Lysozyme is a heat stable protein of mucolytic enzyme type. It is
contained in tissue fluids of animals and plants. Lysozyme is produced by monocytes and
tissue macrophages. It causes lysis of many saprophytic bacteria, providing a less
pronounced lytic effect on the number of pathogenic micro-organisms and is inactive
against viruses. Mechanism of bacteriolytic action of lysozyme is the hydrolysis of bonds
between N-acetylmuramic acid and N-acetylglucosamine in the polysaccharide chains of
peptidoglycan layer of the cell wall of bacteria. This leads to a change in its permeability,
accompanied by the diffusion of cellular content into the environment, and cell death.
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The importance of the microflora of the human body. The normal microflora is
one of the factors of nonspecific resistance of the organism. It possesses antagonistic
properties against pathogenic and putrefactive microflora, participates in water - salt
metabolism, regulation of gas composition in the intestine, the metabolism of proteins,
carbohydrates, fatty acids, cholesterol, nucleic acids, and also in the production of
biologically active compounds: antibiotics, vitamins (K, of B group, etc.), toxins, etc.
Carries on the digestion and detoxification of exogenous substrates and metabolites.
PREVENTION OF INFECTIOUS DISEASES IN PRESCHOOL EDUCATIONAL
INSTITUTIONS
Krichko M. - the 6-th year student.
Scientific leaders – P.K Soldatkin.
Children with suspected infectious diseases are not allowed. The following is necessary:
timely identification of patients and carriers of infection, their isolation from the healthy
ones; avoiding contact of healthy persons with contaminated objects healthy; strict
observance of sanitary-hygienic and sanitary and anti-epidemic regime in institutions and
at home. If you suspect a child is isolated disease. Medical employee must fill out an
emergency notification card and send it to the Federal Service; notify the institution's
management. Sanitary and anti-epidemic measures, are conducted all measures are taken
to control all the children and staff contact.
Preventive measures: the formation of the body immunity in children, isolation of groups,
observance of sanitary regulations, the air mode, quartz treatment of group premises.
Classes in physical training and aesthetics are necessary as well. Air mode is an essential
element of prevention of respiratory diseases. Proper organization of child nutrition.
Physical education and tempering.
Epidemiology: medical check-ups; systematic observation; preventive vaccinations.
FAR EAST SCARLET-LIKE FEVER - A DISEASE OR SYNDROME
Ondar S. - the 6th year student
Scientific leaders – P.K. Soldatkin, E.A. Volosenkova
In 1959, in Vladivostok there was a major outbreak of a previously unknown disease.
Because of the similarity with scarlet fever it was called "far East scarlet-like fever" (DSL).
DSL is a new clinical-epidemiological form of pseudotuberculosis of a person. The source
and reservoir of infection are pets and animals (rodents), soil. Infection occurs with the use
of products not subjected to thermal treatment (cabbage, carrots, apples). In a total
morbidity the proportion of children aged from 1 to 14 years is quite high.
Clinic: scarlatina-like form is the most common form of pseudotuberculosis, characterized
by fever, scarlatina-like rash and symptoms of general intoxication, which are combined
with symptoms of pharyngitis, scleritis. Symptoms of local lesions are mild or absent.
Children often combine this form with hepatic, intestinal, angina and arthralgic form.
Treatment: antibacterial drugs (chloramphenicol, furazolidone). In severe forms
chloramphenicol succinate is administered intramuscularly at 30 - 50 mg/kg of body
weight. During intoxication, infusion therapy is conducted, proteolysis inhibitors on a
background of diuretics, desensitizing medications and vitamins. The prognosis is
favorable.
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BILIARY ATRESIA
Dashieva D., Ondar S. – the 6th year students
Scientific leaders – S.N. Nedid, E.A. Volosenkova
Atresia of bile ducts (biliary atresia) - is a progressive necroinflammatory
idiopathic disease, occurring with lesions of extrahepatic bile ducts, leading to the
development of cholestasis manifested in the newborn period, and in the later stages of the
process intrahepatic bile ducts are involved as well.
There are 3 types of biliary atresia:
Atresia, stenosis of the common bile duct with the formation of a cyst. It is an absolutely
correctable disorder.
Atresia or stenosis of the common hepatic duct with residual lesion of the right or left
lobar duct.
Atresia of internal and external bile ducts is a severe disorder.
With the rapid increase of biliary hypertension, Kasai operation is being performed,
it includes the creation of an anastomosis between the liver and the intestines. Liver
transplantation is carried out only in case of the damage of patency of intrahepatic bile
ducts and increasing liver failure.
Biliary atresia – is a progressive disease that can only be stopped by drainage of
the biliary tract. The key prognostic factors are experience of the surgeon and the patient's
age. This operation is performed for children at the age of 2 months, in this case it provides
more than 70% survival. Children older than 2 months of age have 27% and over 3 months
of age - only 11% survival rate.
BIOPHYSICAL BASES OF SOUND PERCEPTION
Bazarsadueva N. – the 2nd year student
Scientific leaders – Assoc. Prof. T.L. Ogorodnikova, E.A. Volosenkova
SOUNDS are mechanical vibrations perceived by the ear.
The world around us can be called a world of sounds. There are people's voices, the music,
the sound of wind, the chirping of birds, the roar of engines and rustling leaves around us.
Hearing the sound, a person may experience a variety of feelings. A wide variety of
emotions is caused by the most complex set of sounds that we call music. Sounds are the
basis of the speech, which is the main means of communication in human society.
A sound source is vibrating body (for example, speaker cones, the membrane phones
and string musical instruments). For sound propagation elastic medium such as air is
necessary. The moon has no atmosphere, so there is no sound there. Elastic bodies are good
sound’s conductors. Most metals, trees, gases and liquids are elastic bodies and so they are
good sound conductors. So, under the water sounds of propellers and hitting stones are
clearly audible. The fish hear steps, the voices of people on the beach, it is well known to
fishermen. The sound of a moving train can be heard if you put your ear to the rails, as the
sound travels by them better than by air. By applying your ear to the ground, you can hear
the clatter of a galloping horse.
And now look at how sound is perceived. Receiver of sound in a person is the
hearing organ. Sound perception is produced by special cells of the organ of Corti, which
are called fibrous.
Man usually perceives sounds with a frequency of 15 to 20,000 Hz (range 10-11 octaves).
In children, the upper limit is up to 22,000 Hz, with age, it decreases. So, in the elderly the
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upper limit of sound perception is reduced to 6000 Hz. They do not hear, for example, a
mosquito squeak, which produces sounds with a frequency of approximately 20,000 Hz.
THE EFFECT OF HIGH AND LOW TEMPERATURES ON THE HUMAN BODY
Palachik T., Doenina O – the 3rd year students
Scientific leaders - E.V. Litovchenko, E. A. Volosenkova
Even in ancient times, our ancestors knew that health and all the vital processes
also depend on the weather and other natural phenomena.
The effect of temperature on the body is most pronounced in the industrial environment
where there may be high or very low temperatures. Long stay of a person in such conditions
causes stress of thermoregulatory mechanisms, which is regarded as a stressful situation.
Low air temperature, increasing the heat creates the risk of hypothermia. Abrupt decrease
in the air temperature is Especially harmful to human health.
Cold reduces aggression, rejuvenates and prolongs life, improves sleep, helps to
heal diseases, lose weight and get rid of depression.
Under the influence of bath procedure, the body's ability to work and its emotional
tone increase recovery processes after intense and prolonged physical activity accelerate.
As a result of regular visits to the bath the body's resistance to colds and infectious diseases
increases. Stay in the sweating room causes dilation of blood vessels, increases blood
circulation throughout the body. Under the influence of high temperature sweat is
intensively exuded to assist the removal of harmful products of metabolism from the body.
For a long time scientists thought the warmer weather was more comfortable for
the human body, but, having studied the effect of the cold in detail, they found that the low
temperature is more useful for health. Scientists of Harvard University have proved that
heat for a human is five times more dangerous than the cold. Mortality in severe cold,
increases by 1.59%, but it is still lower than the mortality rate in the intense heat, which
increases by 5.74%.
EPIDEMIOLOGICAL FEATURES OF PNEUMONIA
Markova T., Danchenko C., – the 4th year students
Scientific leaders - Doc. Med. Sc. O. A. Tanchenko, E. A. Volosenkova
The improvement of preventive measures against infections of the upper and lower
respiratory tract is one of the most important activities of Federal Executive bodies
exercising the state sanitary-epidemiological supervision.
According to the CPS since 2009, the CPS introduced operational weekly monitoring
for community-acquired pneumonia (CAP) in constituent entities of the Russian
Federation. As a result of analysis of materials submitted to the Federal service for 5 years,
we can say that the structure of the patients with CAP in Russian Federation includes
mostly the adult population, but children under 17 years constitute about 30.0%. Towndwellers, constituting about 80 % of the victims, are more common.
In 2015, the incidence of CAP in the whole Russia made up 337.8 per 100 thousand
population. The excess of the indices in comparison with average levels across the country
was in 45 regions.
According to the forms of state statistical observation over the 2011-2013 43-44%, in
2014 – 31,8%, and in 2015 – 30.2% of the CAP had a bacterial nature.
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Pneumonia is contagious, so you should limit contacts with sick people, in times of
epidemics avoid visiting places with large crowds. As there are vaccines against many
pathogens of pneumonia, it is necessary to conduct vaccination among children and
persons over 65, and people with severe chronic diseases - specific prophylaxis of
pneumonia. At present for such vaccination three kinds of products are used: prevenar,
pneumo 23, ACT Hib. The most common complications of lobar pneumonia are pleurisy,
pericarditis, focal nephritis, abscesses and gangrene of the lungs, acute respiratory failure,
infectious-toxic shock.
Thus, compliance of epidemiological regime, timely diagnosis, optimal doses of
medicine can improve the situation of pneumonia, and avoid complications.
ARTERIAL HYPERTENSION IN PATIENTS WITH METABOLIC SYNDROME
Bigun A., Gamza B., Usik O. - the 3rd year students
Scientific leaders - Can.Med.Sc. I.V. Sklyar, E.A. Volosenkova
The aim of our study was to evaluate the effectiveness of the blocker of receptors
AT ΙΙ- losartan and angiotensin-converting enzyme inhibitor (ACE) - enalapril in the
treatment of arterial hypertension (AH) in patients with metabolic syndrome (MS).
The study included 58 patients with MS. Women made up 71.4%, men - 28.6%.
The average age of the patients - 57,3 ± 6,3 years. Waist - 106,9 ± 4,9 cm.
Depending on the assigned antihypertensive therapy, the patients were divided into
2 groups: group 1 (n = 30) received Losartan ( "Prezartan», IPCA, India) 50 mg / day,
group 2 (n = 28) - enalapril. ( "Enalapril", LLC "Ozone", Russia) 20 mg / day. In the main
clinical, laboratory and instrumental parameters the groups did not differ significantly.
All patients underwent a complete clinical and laboratory research. Quality of life
(QoL) was assessed using a common questionnaire SF-36. The survey was conducted
before and after 6 months of treatment.
Results showed that after the treatment in group 1 target blood pressure (BP) was
in 28 (93.3%) patients, and in the 2nd group – in 20 (71.4%) patients. Patients in both
groups showed significant improvements in intracardiac hemodynamics. On the
background of therapy in the 1st and 2nd groups indicators of lipid blood spectrum, the
level of glucose, plasma potassium concentration were not significantly changed. Before
the treatment, 12 (40%) and 11 (39.3%) patients of the 1st and 2nd groups had
microalbuminuria accordingly. By the end of follow-up, more significant decline in
microalbuminuria (p <0.01) was detected in patients of the 1st Group compared with
patients of the 2nd Group (p <0.05). After treatment, patients in both groups increased life
quality parameters on the scales: assessment of general health (p <0.01), vitality (p <0.01),
physical activity, social activity, the role of emotional problems in the vital activity
restriction (p <0.05 ), while in group 1 QOL indices were higher than in the 2nd group.
Thus, treatment of AH with losartan in MS contributes to the achievement of target
level of blood pressure, improves the indices of intracardiac hemodynamics, reducing the
risk of developing cardiovascular complications, improves the quality of life of these
patients.
MICROBIOLOGICAL DIAGNOSIS OF CANDIDIASIS
Dmitrieva D., Homenko K. – the 3rd-year students
Scientific leaders - Bubinets O.V., Volosenkova E. A.
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Candidiasis (candidiasis) is an opportunistic infectious disease of the skin, mucous
membranes and internal organs, caused by yeast fungi of the Candida genus of the
Cryptococcaceae family of the Deuteromycetes class. The main causative agent is Candida
albicans, rarely - C. tropicales, C. krusei, C. guillermondii, S. lusitaniae. Microbiological
diagnosis of candidiasis includes microscopy of pathological material, isolation of pure
cultures of fungi, conducting serological tests and putting allergy tests. In local and
systemic forms of the disease material for research is taken from affected areas - skin
flakes, scrapes from nails, mucus, pus, sputum, urine, bile, cerebrospinal fluid, stool, in
generalized - blood, punctuates of abscesses, biopsy material from cadavers - blood from
the heart, pieces of parenchymal organs.
The relevance of our work is the problem of candidiasis at the present stage in our society.
PROBLEMS OF MORBIDITY OF ELDERLY PEOPLE
Burumbaeva V., Galagan D. - the 5th year students
Scientific leaders – Assoc.Prof., Sundukova E.A., Volosenkova E.A.
The severity of the problem is determined by the fact that, in particular, the incidence
of elderly patients (61-75 years) 2 times, senile (76-90 years) - 6 times, the need for
outpatient care - 2-4 times, for stationary for certain types of specialized care (cardiology,
endocrinology, pulmonology, urology, ophthalmology, neurology, psychiatry, oncology,
etc.) - 1.5-3 times is higher than that of people of working age.
The development of geriatric services in Russia is dictated by the progressive aging
of the population, the rising morbidity of the elder people, features of pathology of older
age groups of people and the need to improve the organization of their social and
psychological support.
General morbidity of Russia's population is growing. It has increased from 158.3
million cases in 1990 to 207.8 million cases in 2005, ie, for 31%. Morbidity of individuals
aged 60 and older is 1.5-2 times higher than the morbidity for average aged people. As it
was expected, the incidence of elderly Russians is characterized by polymorbidity, when
each one of the patients has 3-5, and often a larger number of diseases.
There are the following features of the pathology of elderly people: polymorbidity,
a chronic course of disease (diseases), effacement of the clinical picture and the severity of
the process, the drug pathomorphosis, delays in seeking for medical care, changeable
pharmacokinetics and thus pharmacodynamics of drugs, forced to polytherapy and quite
rather frequent polypharmacy in conjunction with drug addiction, very often impossibility
to receive adequate medical care, a complex tangle of personal, social, household and
medical problems which led to the appearance of a new for Russia specialty "physician
geriatrician."
Currently, there are a number of barriers that negatively affect the state of health of
the elderly, which need to be addressed within the health system development in Russia.
The health status of elderly and senile patients is characterized by:
1) Progressively increasing with age, exposure to diseases - disease of the cardiovascular
system, diseases of the respiratory and digestive organs, chronic diseases of the joints,
organs of vision and hearing, diabetes, diseases of the central nervous system and cancer
are allocated among them;
2) The presence of several simultaneously occurring chronic diseases (polymorbidity);
3) The combined effect on the body condition of pathological and age-related changes,
which leads to the "atypical" clinical manifestations of disease;
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4) Decrease of the effectiveness of functional and adaptive mechanisms.
5) Gradually growing loss of the ability to self-service, which is most often caused by
diseases of the musculoskeletal system, diseases of the cardiovascular and nervous
systems, the organs of sight and hearing diseases and diabetes;
6) Decompensation, exhaustion and failure of adaptive-compensatory homeostatic
mechanisms which are progressing in conjunction with senile infirm and old age diseases.
NEW FACTS ABOUT CHOLERA VIBRIO
Kiselko M. – the 5th year student
Scientific leaders - P.K.Soldatkin, E.A.Volosenkova
"Secretory system of type VI» (T6SS) - molecular complex consisting of proteins
of viral origin, whereby bacteria-killers pierce shell of neighboring cells and introduce
toxic substances. Neighbors killing with T6SS in cholera vibrio relate to the borrowing of
genetic information from dead cells. These genes are included in response to adverse
conditions. Insertion of foreign genes occurs by substituting its own DNA fragment to
fragment like borrowed (horizontal gene transfer). Genes of vibrio necessary for "natural
transformation", are included in response to the same signals as the genes responsible for
the formation of T6SS, a neighboring cell killing dramatically increases the likelihood of
integration of victims genes in the genome of killer cells.
Each strain of vibrio has the immunity to the toxic "effector" produced by itself.
Several genes which are necessary for the absorption of a foreign DNA are involved in
response to a combination of the two stimuli. The first stimulus is chitin. In the presence
of chitin vibrio begins to produce a regulatory protein-TfpX (transformation protein X).
The second signal is the high density of vibrio population, that microbes evaluate
for concentration of substances secreted by them (autoinducer) using quorum sensing
system.
Thus cholera vibrio through HGT can quickly adapt to changing conditions,
including a new antibiotic, transferring resistance genes from one strain to another.
BACTERIAL ACUTE INTESTIONAL INFECTIONS, FEATURES OF THEIR
OCCURRENCE
Labzenko S. - the 5-th year student.
Scientific leaders - P.K.Soldatkin, E.A.Volosenkova.
Acute intestinal infections continue to be relevant in connection with a high incidence,
especially in the life of 1 year old children.
Shigellosis. Shiqella - causative agent of dysentery. The main factor of shigella virulence
is the ability to the invasion and intraepithelial proliferation.
Salmonellosis. The main factors of pathogenicity of Salmonella is their ability to penetrate
into macrophages and multiply in them, as well as the production of endotoxin.
Ehsherihioza are presented by 5 groups. EPKP - occur in young children and are evident
as diarrhea with symptoms of intoxication and the development of sepsis process EIKP occur in older children. Acute illness begins with fever, weakness, headache, vomiting,
cramping pains abdominal. Intoxication is short. ETKP - diarrhea, cramping abdominal
pains, nausea and vomiting. Stool is watery, bristling, without patologic contaminants and
odor. EGKP - with expressed signs of intoxication, severe cramping abdominal pains,
copious stool with color of "meat slops", intense abdominal pains, the development of
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hemolytic-uremic syndrome. EAKP - cause dehydration in children with
immunodeficiency, affecting the small intestine, biliary, urinary system with the
development of purulent inflammation.
Thus, knowledge of the peculiarities of the AII caused by the PM, will enable the correct
use of antibiotics in the complex therapy to solve the problem.
MANIFESTATIONS AND TREATMENT OF SHIFT-LIKE SCHIZOPHRENIA
Ermolaev I., Minko E., Moskvitin D., Gushin D. - the 4th year students
Scientific leaders – Bagrova M.I., Volosenkova E.A.
Shift-like schizophrenia is an episodic-like progressive form of the disease among
the most common types of pathology. Its characteristic feature is the combination of two
types of pathological process - batch and continuous. Each new attack is accompanied by
the appearance of new positive symptoms, in contrast to other forms, where the
predominant violations worsening available earlier in history. The pathogenesis of
schizophrenia today is generally not fully understood. A significant factor in the
development of shift-like form is considered to be genetic and constitutional factors. More
aggressive course was observed in men than in women. Most pathology takes its
development even during adolescence, so that after a while becomes cancerous in nature
and often leads to dementia. Characteristically the occurrence of acute episodes with clear
intervals between attacks. Some of them pass without a trace, others leave permanent mark
on the psycho-emotional background of the disease. The problem of drug treatment is
lifelong reception of drugs that can lead to the development of Parkinson drug. Along with
medication therapy is important. Support the patient, both on the part of the attending
physician and relatives. Irritability and skepticism to delusions can only lead to the patient's
aggression and its detachment from relatives. Treatment can take place either in a hospital
or on an outpatient basis, the choice depends on the patient's condition. If there is a danger
to himself or the environment, when the patient overcomes thoughts of suicide or a murder
in this case it is necessary to start treatment in a hospital, in order to avoid an accident. The
decision on the need, or lack of it takes psychiatrist who observes the patient.
TREATMENT AND MODES OF CHEMOTHERAPY IN PATIENTS WITH
TUBERCULOSIS
Ruditsa N., Dashieva D. – the 6th year students
Scientific leaders - O.A. Karakulova, E. A. Volosenkova
Treatment of tuberculosis patients includes 5 chemotherapy regimens:
The first chemotherapy regimen is prescribed to all TB patients with bacterial, excretion
confirmed by microscopy and bacterial seeding; newly diagnosed TB patients with
bacterial excretion confirmed by microscopy and drug-resistant pathogen; patients with
recurrent TB, TB patients with established molecular-genetic method of drug susceptibility
of pathogen; TB patients with extrapulmonary localizations without bacterial excretion.
The second mode of chemotherapy is prescribed to patients with tuberculosis when it’s
determinated with molecular-genetic and the cultural methods that the pathogen is
resistant to isoniazid or isoniazid in combination with other drugs, but susceptible to
rifampicin.
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The third chemotherapy mode is prescribed to patients without bacterial excretion
confirmed by microscopy and culture seeding; newly diagnosed TB patients, except cases
of significant contact with TB patients;
The fourth standard chemotherapy mode is prescribed to patients with established TB drug
resistance of pathogen to rifampicin only or isoniazid and rifampicin with unknown drug
sensitivity to other drugs.
Fourth individualized chemotherapy mode is prescribed to TB patients with established
drug resistance of pathogen to isoniazid and rifampicin, and susceptibility to ofloxacin.
Fifth chemotherapy mode is prescribed to patients with established TB drug resistance.
LABORATORY DIAGNOSIS OF BACTERIAL INFECTIONS
Dashieva D. – the 6th year student
Scientific leaders - P. K. Soldatkin, E. A. Volosenkova
The main methods used for the laboratory diagnosis of bacterial infections are a
direct microscopy, culture method, immune and enzyme analysis, immunofluorescence
reaction and the polymerase chain reaction. The material for the study are blood, urine,
feces, cerebrospinal fluid, mucus from the throat or nose, vaginal or cervical scraping,
scraping of the urethra.
Bacteriological method includes collection of the material from the patient,
isolation of pure culture and its identification with the definition of sensitivity to antibiotics
and chemotherapeutic drugs.
Sensitive methods, when the antigen of bacteria are sorbed on the surface of red
blood cells (erythrocyte diagnostic tools) are applied.
Direct (PHA) and indirect hemagglutination (IHA). The reaction of precipitation
in botulism and anthrax - is Ascoli reaction for its diagnosis in animals, complement
fixation (brucellosis, toxoplasmosis, leprosy, glanders).
The cultural method is one of the most accurate methods, but its implementation
requires considerable time. In IFA total antibodies and / or antigens of bacteria are
determined by detecting various immunoglobulins. During the RIF antigens of the
pathogen are being determined. PCR – is a definition of nucleic acids (RNA or DNA) of
the pathogen in the biological fluids.
COCHLEAR IMPLANTATION
Avchelupova A.V. - the intern
Scientific leaders – Can. Med. Sc. V.V.Antipenko, E.A. Volosenkova
A cochlear implant is an electronic medical device that replaces the function of the
damaged inner ear. Unlike hearing aids, which make sounds louder, cochlear implants do
the work of damaged parts of the inner ear (cochlea) to provide sound signals to the brain.
Whom can they help? Cochlear implants can help people who have from moderate to
profound hearing loss in both ears or profound hearing loss in one ear with normal hearing
in the other ear, in this case people may, receive little or no benefit from hearing aids .
Many people suffer from hearing loss because their hair cells in the inner ear (or cochlea)
are damaged. The cochlear implant enables the sound to be transferred to your hearing
nerves and enables you to hear. A sound processor worn behind the ear or on the body,
captures sound and turns it into digital code. It is transmits the digitally-coded sound
through the coil on the outer side of the head to the implant. The implant converts the
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digitally-coded sound into electrical impulses and sends them along the electrode array
placed in the cochlea (the inner ear). Cochlear implant stimulates the cochlea's hearing
nerve, which then sends the impulses to the brain where they are interpreted as a sound.
What are the benefits of a cochlear implant? Many people with cochlear implants report
that they hear better. They feel safely in the world as they can hear alarms.
FEATURES OF DIAGNOSTICS AND TREATMENT OF THE DIABETES
MELLITUS OF TYPE 1
Timofeeva M., Polyashova A. – the 4th year students.
Scientific leaders - Assoc. Prof., Can. Med. Sc. O.A. Tanchenko, E.A. Volosenkova
Diabetes mellitus of type 1 is the most severe form of Diabetum (10% of all cases).
The highest case rate is in children of 10-15 years.
Forms of diabetes mellitus of type 1: autoimmune and idiopathic. Development of
an autoimmune form of a diabetes mellitus of type 1 begins at children's age more often.
At the same time autoantibodies to structural components of β-cells are revealed. As a
result of this process autoimmune disintegration of β-cells develops. Idiopathic form - is
the lack of immunological and genetic factors of diabetes mellitus of type 1, but there are
symptoms confirming absolute deficiency of insulin.
Diabetes mellitus of type 1 is a multifactorial disease. An etiological factor is the
combination of genetic influences with influence of adverse factors of the external
environment. Risk group includes children having an obesity, with low-active lifestyle,
having diathesis, and frequent diseases. Secondary forms develop in endocrinopathies,
pancreas diseases. It is interesting to note that in Diabetes mellitus of type 1 the beginning
of a disease is acute, can become apparent by a severe form of a ketoacidosis or a diabetic
coma. Hard proceeding viral infection can sometimes precede the beginning of a disease.
Analyzing the last references on treatment of DM of type 1, the following algorithm of
therapy is developed: 1) Insulin therapy. 2) Development of the special program of a diet.
3) Prophylaxis of hypoglycemia connected with physical activity.
Thus, knowledge of above-mentioned features of diagnostics and treatment of
Diabetes mellitus of type 1 allows to make in due time the diagnosis and to carry out the
adequate therapy referred on prevention of development of acute and chronic
complications of diabetes mellitus of type 1 which sharply reduce quality and life
expectancy.
VITAMINS OF GROUP D
Ionova N. – the 2nd year student
Scientific leaders – Assoc.Prof. G.K.Doroshenko, O.I.Katina
Vitamins of group D are formed under the influence of ultraviolet in tissues of
animals and plants of sterols.
Vitamins of group D include:
D2 vitamin - an ergocalciferol; it is allocated from yeast, its provitamin is ergosterol;
D3 vitamin - cholecalciferol; it is allocated from tissues of animals; its provitamin
–is 7-degidrocholesterin;
D4 vitamin - 22, a 23-dihydro-ergocalciferol;
D5 vitamin - 24-ethylcholecalciferol (sitocalciferol); it is allocated from wheat oils;
D6 vitamin - 22 dihydroethylcalciferol (stigma-calciferol).
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At present two vitamins are called vitamin D. They are vitamins D2 and D3 - an
ergocalciferol and cholecalciferol. These are crystals without color and a smell, steady in
influence of high temperatures. These vitamins are liposoluble, i.e. they are dissolved in
fats and organic compounds but are water-insoluble.
Vitamin D is formed in skin under the influence of sunshine from provitamins. In
turn, the provitamins partially enter an organism from plants (ergosterol, a stigmasterol and
sitosterin) and are partially formed in tissues from cholesterin (7-dehydrocholesterin
(provitamin of D3 vitamin).
The main function of vitamin D - is ensuring normal body growth and development
of bones, the prevention of rickets and osteoporosis. It regulates mineral metabolism and
promotes adjournment of calcium in a bone tissue and a dentine interfering with an
osteomalacia (softening) of bones.
Vitamin D is unique. It is the only vitamin acting as vitamin, so as hormone. As
vitamin it supports the level of inorganic P and Ca in blood plasma above threshold index